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1. Effectiveness, safety and economic viability of daycare versus usual hospital care management of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh: a cluster randomised controlled trialResearch in context

Author

Nur H. Alam, Abu S. Faruque, Hasan Ashraf, Mohammod J. Chisti, Tahmeed Ahmed, Marufa Sultana, Md Khalequzzaman, Shahjahan Ali, Shahnawaz Ahmed, Sabiha Nasrin, Md Tariqujjaman, K.A.T.M Ehsanul Haque, Ruhul Amin, Abid Hossain Mollah, Lutful Kabir, Mohammod Shahidullah, Wahida Khanam, Khaleda Islam, Minjoon Kim, Maya Vandenent, Trevor Duke, Niklaus Gyr, and George J. Fuchs

Subjects
Severe pneumonia, Daycare, Hospitalisation, Cost-effectiveness, Bangladesh, Medicine (General), R5-920
Abstract

Summary: Background: We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods: This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2–59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings: In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, −3.9 percentage point; 95% confidence interval (CI), −4.8 to −1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95% CI, 92.2 to 96.3) and US$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation: In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding: UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland.

Published
2023
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2. Trends and correlates of low HIV knowledge among ever-married women of reproductive age: Evidence from cross-sectional Bangladesh Demographic and Health Survey 1996-2014.

Author

Md Tariqujjaman, Md Mehedi Hasan, Mohammad Abdullah Heel Kafi, Md Alamgir Hossain, Saad A Khan, Nadia Sultana, Rashidul Azad, Md Arif Hossain, Mahfuzur Rahman, and Mohammad Bellal Hossain

Subjects
Medicine, Science
Abstract

BackgroundThe human immunodeficiency virus (HIV) burden has frequently been changing over time due to epidemiological and demographic transitions. To safeguard people, particularly women of reproductive age, who can be exposed to transmitting this burden to the next generation, knowledge regarding this life-threatening virus needs to be increased. This research intends to identify the trends and associated correlates of "low" HIV knowledge among ever-married women of reproductive age in Bangladesh from 1996 to 2014.MethodsWe analyzed data derived from six surveys of Bangladesh Demographic and Health Surveys conducted in 1996, 1999, 2004, 2007, 2011, and 2014. Analyses were primarily restricted to ever-married women aged 15-49 years who had ever heard of HIV. The correlates of "low" HIV knowledge were investigated using multiple binary logistic regression models.ResultsThe study found that the proportion of women with "low" HIV knowledge decreased from 72% in 1996 to 58% in 2014. In adjusted models, age at first marriage, level of education, wealth quintile, and place of residence (except in the survey year 2011) were found to be potential correlates of "low" HIV knowledge in all survey years. In the pooled analysis, we found lower odds of "low" HIV knowledge in the survey years 1999 (Adjusted Odds Ratio: 0.67; 95% CI: 0.57, 0.78), 2004 (AOR: 0.60; 95% CI: 0.52, 0.70), 2007 (AOR: 0.51; 95% CI: 0.44, 0.60), 2011 (AOR: 0.36; 95% CI: 0.32, 0.42) and 2014 (AOR: 0.47; 95% CI: 0.41, 0.54) compared to the survey year 1996.ConclusionThe proportion of "low" HIV knowledge has declined over time, although the proportion of women with "low" HIV knowledge still remains high. The prevention of early marriage, the inclusion of HIV-related topics in the curricula, reduction of disparities between urban-rural and the poorest-richest groups may help to improve the level of HIV knowledge among ever-married Bangladeshi women.

Published
2023
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3. Geographical variations of food insecurity and its associated factors in Bangladesh: Evidence from pooled data of seven cross-sectional surveys.

Author

Md Tariqujjaman, Mahfuzur Rahman, Kinley Wangdi, Gobinda Karmakar, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Medicine, Science
Abstract

Food insecurity has multiple negative effects on maternal and child health and nutritional outcomes. There is a dearth of up-to-date evidence on the prevalence of food insecurity in Bangladesh based on geographical variations. We investigated the prevalence of food insecurity based on geographical variations and its associated factors. We pooled data from seven cross-sectional surveys conducted in 15,009 households from March 2015 to May 2018. This study was a part of the evaluation of the Maternal Infant Young Child Nutrition Phase 2 programme implemented by BRAC, one of the largest international non-governmental organizations located in Bangladesh that covered rural areas in 26 districts and two urban slums in Dhaka, Bangladesh. We used Household Food Insecurity Access Scale (a widely used scale to measure household food insecurity) to estimate the food insecurity status from the data collected through a face-to-face interview using a structured questionnaire. Hot spot analysis was conducted using the Getis-Ord Gi* statistic. The multiple logistic regression model was applied to explore the associated factors of food insecurity. The food insecurity hotspots were in the northwestern, central-southwestern, and coastal districts of Bangladesh. The overall prevalence of mild, moderate, and severe food insecurity were 12.7%, 13.8%, and 3.5%, respectively. In the adjusted model, household heads and caregivers of children with five or more years of schooling had respectively 42% (adjusted odds ratio (AOR): 0.58, 95% confidence interval (CI): 0.52, 0.64) and 46% (AOR: 0.54; 95% CI: 0.49, 0.61) less likelihood to suffer from food insecurity. Households in the middle (AOR: 0.58, 95% CI: 0.52, 0.65) and rich (AOR: 0.32, 95% CI: 0.28, 0.36) wealth status had lower odds of food insecurity. Food insecurity is widely spread in rural districts of Bangladesh and the degree of vulnerability is higher among the households of the northwestern, central-southwestern, and coastal areas of Bangladesh. Comprehensive interventions including strategies for poverty reduction and education for all might be effective to reduce food insecurity at rural households in Bangladesh.

Published
2023
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4. Can complex programs be sustained? A mixed methods sustainability evaluation of a national infant and young child feeding program in Bangladesh and Vietnam

Author

Corrina Moucheraud, Haribondhu Sarma, Tran Thi Thu Ha, Tahmeed Ahmed, Adrienne Epstein, Jeffrey Glenn, Hoang Hong Hanh, Tran Thi Thu Huong, Sharmin Khan Luies, Aninda Nishat Moitry, Doan Phuong Nhung, Denise Diaz Payán, Mahfuzur Rahman, Md Tariqujjaman, Tran Thi Thuy, Tran Tuan, Thomas J. Bossert, and Margaret E. Kruk

Subjects
Sustainability, Mixed methods, Global health, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Poor early-life nutrition is a major barrier to good health and cognitive development, and is a global health priority. Alive & Thrive (A&T) was a multi-pronged initiative to improve infant and young child feeding behaviors. It aimed to achieve at-scale child health and nutrition improvements via a comprehensive approach that included nutrition counseling by health workers, policy change, social mobilization and mass media activities. This study evaluated the sustainability of activities introduced during A&T implementation (2009–2014) in Bangladesh and Vietnam. Methods This was a mixed methods study that used a quasi-experimental design. Quantitative data (surveys with 668 health workers, and 269 service observations) were collected in 2017; and analysis compared outcomes (primarily dose and fidelity of activities, and capacity) in former A&T intervention areas versus areas that did not receive the full A&T intervention. Additionally, we conducted interviews and focus groups with 218 stakeholders to explore their impressions about the determinants of sustainability, based on a multi-level conceptual framework. Results After program conclusion, stakeholders perceive declines in mass media campaigns, policy and advocacy activities, and social mobilization activities – but counseling activities were institutionalized and continued in both countries. Quantitative data show a persisting modest intervention effect: health workers in intervention areas had significantly higher child feeding knowledge, and in Bangladesh greater self-efficacy and job satisfaction, compared to their counterparts who did not receive the full package of A&T activities. While elements of the program were integrated into routine services, stakeholders noted dilution of the program focus due to competing priorities. Qualitative data suggest that some elements, such as training, monitoring, and evaluation, which were seen as essential to A&T’s success, have declined in frequency, quality, coverage, or were eliminated altogether. Conclusions The inclusion of multiple activities in A&T and efforts to integrate the program into existing institutions were seen as crucial to its success but also made it difficult to sustain, particularly given unstable financial support and human resource constraints. Future complex programs should carefully plan for institutionalization in advance of the program by cultivating champions across the health system, and designing unique and complementary roles for all stakeholders including donors.

Published
2020
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5. Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis.

Author

Sabiha Nasrin, Md Tariqujjaman, Marufa Sultana, Rifat A Zaman, Shahjahan Ali, Mohammod J Chisti, Abu S G Faruque, Tahmeed Ahmed, George J Fuchs, Niklaus Gyr, and Nur H Alam

Subjects
Medicine, Science
Abstract

BackgroundPneumonia is the leading cause of death in children globally with the majority of these deaths observed in resource-limited settings. Globally, the annual incidence of clinical pneumonia in under-five children is approximately 152 million, mostly in the low- and middle-income countries. Of these, 8.7% progressed to severe pneumonia requiring hospitalization. However, data to predict children at the greatest risk to develop severe pneumonia from pneumonia are limited.MethodSecondary data analysis was performed after extracting relevant data from a prospective cluster randomized controlled clinical trial; children of either sex, aged two months to five years with pneumonia or severe pneumonia acquired in the community were enrolled over a period of three years in 16 clusters in urban Dhaka city.ResultsThe analysis comprised of 2,597 children aged 2-59 months. Of these, 904 and 1693 were categorized as pneumonia (controls) and severe pneumonia (cases), respectively based on WHO criteria. The median age of children was 9.2 months (inter quartile range, 5.1-17.1) and 1,576 (60%) were male. After adjustment for covariates, children with temperature ≥38°C, duration of illness ≥3 days, male sex, received prior medical care and severe stunting showed a significantly increased likelihood of developing severe pneumonia compared to those with pneumonia. Severe pneumonia in children occurred more often in older children who presented commonly from wealthy quintile families, and who often sought care from private facilities in urban settings.Conclusion and recommendationMale sex, longer duration of illness, fever, received prior medical care, and severe stunting were significantly associated with development of WHO-defined severe childhood pneumonia in our population. The results of this study may help to develop interventions target to reduce childhood morbidity and mortality of children suffering from severe pneumonia.

Published
2022
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6. Caregiver perceived barriers to the use of micronutrient powder for children aged 6-59 months in Bangladesh.

Author

Mahfuzur Rahman, Md Tariqujjaman, Mustafa Mahfuz, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Medicine, Science
Abstract

BackgroundThe effectiveness of micronutrient powder (MNP) on the health outcome of children is yet to be proved. Although studies identified the barriers to the use of MNP the underlying factors related to the barriers to the use of MNP are still unexplored. We examined the underlying factors associated with the barriers reported by the caregivers of the children aged 6-59 months in Bangladesh.MethodsWe analyzed pooled data of 3, 634 caregiver-child dyads extracted from eight cross-sectional surveys. The surveys were conducted as part of an evaluation of the Maternal, Infant and Young Children Nutrition programme (phase 2) in Bangladesh. We performed univariate analysis to find the barriers reported by the caregivers of the children. We identified the underlying factors related to the reported barriers by performing multiple logistic regression analysis.ResultsThe mostly reported barrier was perceived lack of need for MNP among the caregivers of the children (39.9%), followed by lack of awareness of the product (21.7%) and cost of the product (18.1%). Caregivers of older children (adjusted odds ratio (aOR): 1.69; 95% CI: 1.43, 2.00) and caregivers who maintained good infant and young child feeding practices (aOR: 1.32; 95% CI: 1.12, 1.57) perceived more lack of need for MNP. Caregivers of the female children (aOR: 0.79; 95% CI: 0.63, 0.98) were less likely to report that their children disliked MNP compared to the caregivers of the male children.ConclusionProgrammes intended to effectively promote MNP among the caregivers of children aged 6-59 months should carefully consider the factors that could underlie the barriers to the use of MNP.

Published
2021
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7. The Effects of Deworming and Multiple Micronutrients on Anaemia in Preschool Children in Bangladesh: Analysis of Five Cross-Sectional Surveys

Author

Haribondhu Sarma, Kinley Wangdi, Md Tariqujjaman, Ratish Das, Mahfuzur Rahman, Matthew Kelly, Tahmeed Ahmed, and Darren J. Gray

Subjects
Bangladesh, anaemia, children, deworming, micronutrient powders, Nutrition. Foods and food supply, TX341-641
Abstract

Anaemia is a major public health problem among children < 5 years of age in Bangladesh due to recurrent intestinal parasite infections. The aim of this study was to understand the association between combining deworming and MNP home fortification (MNP + Deworming) and the prevalence of anaemia among children < 5 years of age in Bangladesh. We used pooled data from five cross-sectional surveys and performed multivariable logistic regression and calculated crude and adjusted odds ratios (AORs) to quantify the association of anaemia with the exposure variables. A total of 9948 households were considered for this paper. In the unadjusted logistic regression, no significant association was detected between the effective MNP coverage and anaemia prevalence, but the associations were significant (p < 0.001) between the deworming and anaemia prevalence and between the MNP + Deworming condition and anaemia prevalence. In the adjusted model, children who were exposed to both deworming and effective MNP coverage were 30% (AOR 0.70; 95% CI 0.52, 0.94; p = 0.018) less likely to be anaemic compared with children who were unexposed to combined MNP + Deworming. The combined effects of deworming and MNP supplementation on the reduction in anaemia prevalence highlighted the importance of using integrated and multidisciplinary intervention strategies.

Published
2021
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8. Improving quality of care for maternal and newborn health: a pre-post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh

Author

Herfina Y. Nababan, Rubana Islam, Shabnam Mostari, Md Tariqujjaman, Malabika Sarker, Mohammad Tajul Islam, and Corrina Moucheraud

Subjects
Maternal and newborn health, Safe Childbirth Checklist, Quality of care, Health worker performance, Health service delivery, Bangladesh, Gynecology and obstetrics, RG1-991
Abstract

Abstract Background Bangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. High-quality maternal health care is necessary to address this burden. Implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices. Method The SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. This study was a pre-post evaluation of SCC implementation. Data were collected over 8 months at Magura District Hospital. We analysed 468 direct observations of birth (main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations) from admission to discharge. The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives. Result After checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline (from 11 to 19 out of 27 practices). Substantial increases were seen in communication between nurse-midwives and mothers (counselling), and in management of complications (including rational use of medicines). In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline (95% CI 1.61–1.81). Conclusion Implementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation.

Published
2017
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9. Association of Socio-Demographic and Climatic Factors with the Duration of Hospital Stay of Under-Five Children with Severe Pneumonia in Urban Bangladesh: An Observational Study

Author

K. A. T. M. Ehsanul Huq, Michiko Moriyama, Ryota Matsuyama, Md Moshiur Rahman, Reo Kawano, Mohammod Jobayer Chisti, Md Tariqujjaman, and Nur Haque Alam

Subjects
severe pneumonia, under-five children, length of hospital stay, climate factors, Bangladesh, Pediatrics, RJ1-570
Abstract

Severe pneumonia is one of the leading contributors to morbidity and deaths among hospitalized under-five children. We aimed to assess the association of the socio-demographic characteristics of the patients and the climatic factors with the length of hospital stay (LoS) of under-five children with severe pneumonia managed at urban hospitals in Bangladesh. We extracted relevant data from a clinical trial, as well as collecting data on daily temperature, humidity, and rainfall from the Meteorological Department of Bangladesh for the entire study period (February 2016 to February 2019). We analyzed the data of 944 children with a generalized linear model using gamma distribution. The average duration of the hospitalization of the children was 5.4 ± 2.4 days. In the multivariate analysis using adjusted estimation of duration (beta; β), extended LoS showed remarkably positive associations regarding three variables: the number of household family members (β: 1.020, 95% confidence intervals (CI): 1.005–1.036, p = 0.010), humidity variation (β: 1.040, 95% Cl: 1.029–1.052, p < 0.001), and rainfall variation (β: 1.014, 95% Cl: 1.008–1.019), p < 0.001). There was also a significant negative association with LoS for children’s age (β: 0.996, 95% Cl: 0.994–0.999, p = 0.006), well-nourishment (β: 0.936, 95% Cl: 0.881–0.994, p = 0.031), and average rainfall (β: 0.980, 95% Cl: 0.973–0.987, p < 0.001). The results suggest that the LoS of children admitted to the urban hospitals of Bangladesh with severe pneumonia is associated with certain socio-demographic characteristics of patients, and the average rainfall with variation in humidity and rainfall.

Published
2021
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10. Understanding the socio-demographic and programmatic factors associated with adolescent motherhood and its association with child undernutrition in Bangladesh

Author

Md. Alamgir Hossain, Novel Chandra Das, Md. Tariqujjaman, Abu Bakkar Siddique, Rubaiya Matin Chandrima, Md. Fakhar Uddin, S. M Hasibul Islam, Abu Sayeed, Anisuddin Ahmed, Shams El Arifeen, Hassan Rushekh Mahmood, Ahmed Ehsanur Rahman, and Aniqa Tasnim Hossain

Subjects
Adolescent mothers, Adolescent motherhood, First childbirth, Child undernutrition, Programmatic gaps, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Worldwide, a significant number of girls become mothers during adolescence. In Bangladesh, adolescent childbirth is highly prevalent and has adverse effects on children’s health and undernutrition. We aimed to identify the relationship between the undernutrition of children and adolescent motherhood, the factors associated with adolescent mothers’ age at first birth, and to examine the programmatic factors and gaps influencing children’s undernutrition in Bangladesh. Methods We analysed the ‘Bangladesh Demographic and Health Survey’ BDHS-17-18 data and desk review. To examine the factors associated with adolescent motherhood and its impact on child undernutrition, data from 7,643 mother-child pairs were selected. Child stunting, wasting, and underweight were measured according to the World Health Organisation (WHO) median growth guidelines based on z-scores − 2. Univariate, bivariate, simple, and multiple logistic regressions were used for analyse. We followed the systematic procedures for the literature review. Results Approximately, 89% of adolescents aged ≤ 19 years were married and 71% of them gave their first childbirth. Children of adolescent mothers (≤ 19 years) were significantly 1.68 times more wasted (aOR: 1.68; 95% CI: 1.08 to 2.64), 1.37 times more underweight (aOR: 1.37; 95% CI: 1.01 to 1.86) and either form 1.32 times more stunting, wasting or underweight (aOR:1.32; 95% Cl: 1.05 to 1.66) compared to the children of adult mothers (> 19 years) after adjusting potential confounders. The factors associated with mothers’ first childbirth during adolescence were the age gap between husband and wife 5–10 years (aOR: 1.81; 95% Cl: 1.57–2.10) and age gap > 10 years (aOR: 2.41; 95% Cl: 1.96–2.97) compared with the age group

Published
2024
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11. Influence of child marriage on nutritional status among their under‐five children in Bangladesh: Evidence from Bangladesh Demographic and Health Survey data 2011, 2014 and 2017–18

Author

Murad Alam Khan, Md Ahshanul Haque, Md. Tariqujjaman, Monira Sarmin, Tahmeed Ahmed, and Mustafa Mahfuz

Subjects
Bangladesh, child marriage, multiple‐logistic regression, nutritional outcomes, pooled data, Reproduction, QH471-489, Women. Feminism, HQ1101-2030.7
Abstract

Abstract Objective Child marriage remains a significant concern in Bangladesh, where 38 million girls are married before reaching the age of 18. Child marriage contributes adversely to the health and nutritional status of their offspring. The current analysis investigated the association between maternal child marriage and nutritional outcomes including stunting, wasting and underweight of their under‐five children. Method This study analyzed data from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 2011, 2014 and 2017–2018. The researchers used descriptive statistics and multiple logistic regression analyses, controlling for potential socioeconomic and demographic variables, and adjusted the sample weight in all analyses using Stata. Result The analyses included pooled data of 25 323 ever‐married women and their under‐five children. Results showed that 73% of women were married before the age of 18. Children born to mothers married as children themselves were 19% more likely to be stunted and 13% was underweight but wasting wasn't directly linked to maternal child marriage. Adjusted analysis showed that child marriage was significantly associated with stunting [adjusted odds ratio (aOR): 1.19; 95% confidence interval (CI): 1.08, 1.33], underweight (aOR: 1.13; 95% CI: 1.01, 1.26), wasting (aOR: 1.05; 95% CI: 0.97, 1.13). Conclusion This study observed a high prevalence of child marriage. Maternal child marriage was significantly associated with stunting, and underweight of their under‐five children. Mechanisms underlying these associations need to be explored to develop effective interventions to address these issues.

Published
2024
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12. Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design

Author

Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Mohammad Ashraful Islam, Mduduzi N. N. Mbuya, Grant J. Aaron, Sufia Askari, Catherine Harbour, Rudaba Khondker, Moniruzzaman Bipul, Sabiha Sultana, Mohammad Ashikur Rahman, Shaima Arzuman Shahin, Morseda Chowdhury, Kaosar Afsana, Samik Ghosh, Cathy Banwell, Catherine D’Este, Mihretab Salasibew, Lynnette M. Neufeld, and Tahmeed Ahmed

Subjects
home fortification, micronutrient powder, market-based program, anemia, children, Bangladesh, Nutrition. Foods and food supply, TX341-641
Abstract

BackgroundAnemia poses a significant public health problem, affecting 1.6 billion people and contributing to the loss of 68.4 million disability-adjusted life years. We assessed the impact of a market-based home fortification program with micronutrient powder (MNP) called Pushtikona-5 implemented by Bangladesh Rural Advancement Committee (BRAC) on the prevalence of anemia among children aged 6–59 months in Bangladesh.MethodsWe used a modified stepped wedged design and conducted three baseline, two midline, and three endline surveys to evaluate the Pushtikona-5 program implemented through three BRAC program platforms. We interviewed children’s caregivers, and collected finger-prick blood samples from children to measure hemoglobin concentration. We also collected data on coverage of Pushtikona-5 and infant and young child feeding (IYCF) practices. We performed bivariate and multivariable analysis and calculated adjusted risk ratios (ARRs) to assess the effect of program outcomes.ResultsA total of 16,936 households were surveyed. The prevalence of anemia was 46.6% at baseline, dropping to 32.1% at midline and 31.2% at endline. These represented adjusted relative reductions of 34% at midline (RR 0.66, 95%CI 0.62 to 0.71, value of p

Published
2024
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13. Effect of Gut Microbiota-Directed Complementary Food Supplementation on Fecal and Plasma Biomarkers of Gut Health and Environmental Enteric Dysfunction in Slum-Dwelling Children with Moderate Acute Malnutrition

Author

Ishita Mostafa, Rahvia Alam Sthity, Umme Habiba Lamiya, Md. Tariqujjaman, Mustafa Mahfuz, S. M. Tafsir Hasan, and Tahmeed Ahmed

Subjects
microbiota-directed complementary food, moderate acute malnutrition, gut health, environmental enteric dysfunction, children, Bangladesh, Pediatrics, RJ1-570
Abstract

Dietary supplementation with a gut microbiota-directed complementary food (MDCF-2) significantly improved weight gain and repaired gut microbiota, as reported in a recent randomized controlled trial on Bangladeshi children with moderate acute malnutrition (MAM). Environmental enteric dysfunction (EED) is a small bowel disorder, and recent evidence shows that it is linked to growth failure in children. Therefore, we intended to investigate whether supplementation with MDCF-2 has any role in modifying gut health by changing the levels of biomarkers of EED and gut inflammation in children with MAM. We randomly assigned 124 children aged 12–18 months to one of two intervention diets, either MDCF-2 or ready-to-use supplementary food (RUSF). Approximately 50 g of the diet was administered in two feeding sessions daily for 12 weeks. Stool and plasma biomarkers were assessed to evaluate intestinal health. Results showed that the average change in citrulline concentration (µmol/L) significantly increased among children who consumed MDCF-2 compared to those who consumed RUSF (mean difference-in-differences: 123.10; 95% CI: 3.60, 242.61; p = 0.044). The research findings demonstrated that MDCF-2 might have a beneficial effect on improving the gastrointestinal health of malnourished children.

Published
2024
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14. Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial

Author

Niranjan Kissoon, Tahmeed Ahmed, Karim Manji, Mohammod Jobayer Chisti, Abu Syed Golam Faruque, Md. Tariqujjaman, M Munirul Islam, Monira Sarmin, Nusrat Jahan Shaly, Tania Sultana, Shamima Sharmin Shikha, Nafisa Mariam, Didarul Haque Jeorge, Mosharrat Tabassum, Baitun Nahar, Farzana Afroze, Lubaba Shahrin, Md. Iqbal Hossain, Baharul Alam, Din-E-Mujahid Mohammad Faruqe Osmany, and Chaudhury Meshkat Ahmed

Subjects
Medicine
Abstract

Introduction Diarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation.Methods and analysis In this randomised, three-arm, controlled, non-masked clinical trial in children 1–59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023.Ethics and dissemination This study has been approved by the icddr,b Institutional Review Board. We adhere to the ‘Declaration of Helsinki’ (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar.Trial registration number NCT04750070.

Published
2023
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16. Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

Author

Md. Mehedi Hasan, Sayem Ahmed, Anne Cleary, Fariha Tasnim, Md. Tariqujjaman, and Abdullah Mamun

Subjects
Medicine
Abstract

Objective To examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.Design This study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.Setting Nepal.Participants Adult patients with hypertension.Results Among 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=−0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.Conclusions Undiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.

Published
2020
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17. Geographical variations in the association between bullying victimization and sleep loss among adolescents: a population-based study of 91 countries

Author

Md. Mehedi Hasan, Yaqoot Fatima, Simon S. Smith, Md. Tariqujjaman, Santosh Jatrana, and Abdullah A. Mamun

Subjects
Adult, Male, Schools, Adolescent, Bullying, Humans, Female, General Medicine, Sleep, Students, Crime Victims
Abstract

To examine geographical variations in the association between bullying victimization and sleep loss over worry among adolescents.We used data from the Global School-based Student Health Survey conducted between 2003 and 2017 in 91 countries across the globe. Sleep loss was categorised as: none/minimum (reported never or rarely sleep loss), moderate (reported sometimes), and severe (reported most of the time or always). We obtained country-specific estimates from multiple multinomial logistic regression analyses and pooled estimates from meta-analyses.Of 282,036 adolescents 13-17 years of age, 28.1% (male: 25.4%, female: 31.0%) and 8.4% (male: 7.3%, female: 9.5%) of adolescents reported moderate and severe sleep loss respectively. Adolescents who frequently experienced bullying (≥3 per 30 days) reported higher prevalence of severe sleep loss. Meta-analyses showed that increased frequency of bullying victimization is associated with increased odds of sleep loss, with adolescents who experienced bullying for ≥3 days in the past 30 days were 1.65 and 2.65 times more likely than adolescents without being bullied to experience respectively moderate (OR 1.65, 95% CI: 1.59-1.72) and severe (OR 2.65, 95% CI: 2.52-2.79) sleep loss. Irrespective of sex, the association between bullying victimization and sleep loss was significant in all regions, income groups, and in all but a few countries.Increased frequency of bullying victimization is positively associated with increased sleep loss among adolescents. Appropriate policies and programmes to stop bullying at school could help downgrade the risk of sleep loss among adolescents.

Published
2022

18. Effect of home visits by community health workers on complementary feeding practices among caregivers of children aged 6–23 months in 10 districts of Bangladesh

Author

Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Public Health, Environmental and Occupational Health
Abstract

BackgroundSuboptimal complementary feeding contributes to undernutrition in children aged 6–23 months in low- and middle-income countries like Bangladesh. Multifaceted interventions have been taken to improve complementary feeding practices, but there is limited evidence about the effect of home visits by community health workers (CHWs) on complementary feeding practices of the caregivers of children.MethodsWe collated data from the baseline and the corresponding follow-up survey done as part of an evaluation of Bangladesh Maternal, Infant and Young Child Nutrition (MIYCN) programme. We collected data on complementary feeding practices using a 24-h recall questionnaire. Age-appropriate dietary diversity, minimum meal frequency, and minimum acceptable diet were assessed based on recommended food consumption as per child's age. To understand the effect of CHWs' visits on complementary feeding practices, we performed Generalized Estimating Equation (GEE) procedure for dealing with correlated data and adjusted other covariates.ResultsA total of 758 and 745 caregivers of children aged 6–23 months participated in the baseline and follow-up survey, respectively. Complementary feeding practices were improved in 1 year of programme implementation; dietary diversity increased from 46 to 54%, minimum meal frequency from 82 to 91%, and minimum acceptable diet from 41 to 53%. Caregivers of children who had received the visit of CHWs in the last 12 months prior to the day of the follow-up survey were more likely (AOR 1.51; 95% CI 1.10–2.10) to maintain dietary diversity in their children's feeding practices than the caregivers who had not received a CHW visit in the last 12 months. The likelihood of maintaining a minimum acceptable diet in feeding practices was 1.57 times higher (AOR 1.57; 95% CI 1.14–2.17) among the caregivers who were exposed to the visits of the CHWs in the last 12 months compared to the caregivers who were not exposed to the CHW's visits in the last 12 months.ConclusionIntegration of promotional activities of complementary feeding practices into the mainstream nutrition programme can be instrumental in optimizing complementary feeding practices among the caregivers of the under-five children. However, home visits by CHWs should be prioritized in such an integrated programme.

Published
2023
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19. The Effects of Deworming and Multiple Micronutrients on Anaemia in Preschool Children in Bangladesh: Analysis of Five Cross-Sectional Surveys

Author

Haribondhu Sarma, Kinley Wangdi, Md Tariqujjaman, Ratish Das, Mahfuzur Rahman, Matthew Kelly, Tahmeed Ahmed, and Darren J. Gray

Subjects
Male, deworming, Article, Eating, children, Recurrence, Prevalence, Humans, TX341-641, Micronutrients, Intestinal Diseases, Parasitic, Infant Nutritional Physiological Phenomena, Bangladesh, anaemia, micronutrient powders, Nutrition and Dietetics, Antiparasitic Agents, Nutrition. Foods and food supply, Infant, Anemia, Cross-Sectional Studies, Child, Preschool, Dietary Supplements, Female, Child Nutritional Physiological Phenomena, Food Science
Abstract

Anaemia is a major public health problem among children < 5 years of age in Bangladesh due to recurrent intestinal parasite infections. The aim of this study was to understand the association between combining deworming and MNP home fortification (MNP + Deworming) and the prevalence of anaemia among children < 5 years of age in Bangladesh. We used pooled data from five cross-sectional surveys and performed multivariable logistic regression and calculated crude and adjusted odds ratios (AORs) to quantify the association of anaemia with the exposure variables. A total of 9948 households were considered for this paper. In the unadjusted logistic regression, no significant association was detected between the effective MNP coverage and anaemia prevalence, but the associations were significant (p < 0.001) between the deworming and anaemia prevalence and between the MNP + Deworming condition and anaemia prevalence. In the adjusted model, children who were exposed to both deworming and effective MNP coverage were 30% (AOR 0.70; 95% CI 0.52, 0.94; p = 0.018) less likely to be anaemic compared with children who were unexposed to combined MNP + Deworming. The combined effects of deworming and MNP supplementation on the reduction in anaemia prevalence highlighted the importance of using integrated and multidisciplinary intervention strategies.

Published
2022

20. Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial

Author

Monira Sarmin, Nusrat Jahan Shaly, Tania Sultana, Md. Tariqujjaman, Shamima Sharmin Shikha, Nafisa Mariam, Didarul Haque Jeorge, Mosharrat Tabassum, Baitun Nahar, Farzana Afroze, Lubaba Shahrin, Md. Iqbal Hossain, Baharul Alam, Abu Syed Golam Faruque, M Munirul Islam, Din-E-Mujahid Mohammad Faruqe Osmany, Chaudhury Meshkat Ahmed, Karim Manji, Niranjan Kissoon, Mohammod Jobayer Chisti, and Tahmeed Ahmed

Subjects
General Medicine
Abstract

IntroductionDiarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation.Methods and analysisIn this randomised, three-arm, controlled, non-masked clinical trial in children 1–59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023.Ethics and disseminationThis study has been approved by the icddr,b Institutional Review Board. We adhere to the ‘Declaration of Helsinki’ (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar.Trial registration numberNCT04750070.

Published
2023

21. Stunting Status of Ever-Married Adolescent Mothers and Its Association with Childhood Stunting with a Comparison by Geographical Region in Bangladesh

Author

Md. Ahshanul Haque, Barbie Zaman Wahid, Md. Tariqujjaman, Mansura Khanam, Fahmida Dil Farzana, Mohammad Ali, Farina Naz, Kazi Istiaque Sanin, ASG Faruque, and Tahmeed Ahmed

Subjects
Bangladesh, Adolescent Mothers, Adolescent, Health, Toxicology and Mutagenesis, Malnutrition, digestive, oral, and skin physiology, Public Health, Environmental and Occupational Health, Infant, Mothers, Nutritional Status, food and beverages, nutritional and metabolic diseases, stunting, adolescent, association, Humans, Female, Child, Growth Disorders
Abstract

The adolescence period is considered a life stage worthy of strategic health investments since it is a critical period of physical and neuro-maturational development. Adolescent girls face different health difficulties in that phase of life. Children born to adolescent mothers are at a higher risk of undernutrition. This paper aims to estimate the prevalence of stunting among adolescent mothers and their children in Bangladesh by time period and determine the associated factors of adolescent maternal stunting status. We also sought to establish the relationship between maternal and childhood stunting by comparing the geographical regions in Bangladesh. We derived data from the nationally representative Bangladesh Demographic and Health Survey, which was conducted between 2007 and 2017/18. The outcome variables of this study were ever-married adolescent girls’ stunting status and their children’s stunting status. Interaction analysis between administrative division and maternal stunting status was conducted with childhood stunting as the outcome variable to investigate the impact of maternal stunting status on their children’s stunting compared to geographical location. Our results indicated that in comparison to other divisions, the frequency of stunting among children and adolescent mothers was higher in the Sylhet region. It also revealed that children whose mothers were stunted had a 2.36 times increased chance of being stunted. Our study suggests that education for women could help them attain self-sufficiency and, as a result, reduce the prevalence of poor childhood nutrition, especially stunting.

Published
2022
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22. Determinants of Double Burden of Malnutrition Among School Children and Adolescents in Urban Dhaka: A Multi-Level Analyses

Author

Md. Tariqujjaman, Sifat Parveen Sheikh, George Smith, A. M. Rumayan Hasan, Fatema Khatun, Ashraful Kabir, Md. Harunor Rashid, and Sabrina Rasheed

Subjects
Bangladesh, Cross-Sectional Studies, Adolescent, Thinness, Urban Population, Malnutrition, Public Health, Environmental and Occupational Health, Humans, Obesity, Overweight, Child
Abstract

BackgroundBangladesh faces a double burden of malnutrition, with a rising prevalence of overweight and obesity among children and adolescents parallel to existing undernutrition.ObjectiveThe current study was designed to assess the determinants of double burden of malnutrition among urban school children and adolescents from Dhaka, Bangladesh.MethodsA cross-sectional survey was conducted among 2,690 students from 14 schools in Dhaka city from January to June 2018. Anthropometric measurements were taken during school hours, and self-administered questionnaires were sent to the parents. We performed multi-level multiple logistic regression analyses to assess the determinants of underweight, overweight, and obesity.FindingsThe prevalence of overweight (33%) and obesity (23%) was highest among children and adolescents from high tuition schools but the prevalence of underweight (4%) was lowest compared to those from low (underweight 19%, overweight 17%, and obesity 6%) and medium (underweight 18%, overweight 15%, and obesity 6%) tuition schools. Children and adolescents from high-tuition schools had higher odds of being overweight/ obese (AOR: 2.92; 95% CI: 1.90, 4.49). Parental NCDs and overweight were negatively associated with underweight but positively associated with overweight and obesity among children and adolescents. Lack of physical activity inside schools was positively associated (AOR: 1.26; 95% CI: 1.02, 1.55) with overweight and obesity among school children and adolescents.ConclusionOur results point to opportunities in and outside schools to address the rising prevalence of underweight, overweight, and obesity among urban school children and adolescents.

Published
2022

23. Socioeconomic inequalities in women’s undernutrition: evidence from nationally representative cross-sectional Bangladesh Demographic and Health Survey 2017−2018

Author

Mahfuzur Rahman, Md. Tariqujjaman, Md. Rayhanul Islam, Sifat Parveen Sheikh, Nadia Sultana, Tahmeed Ahmed, Sayem Ahmed, and Haribondhu Sarma

Subjects
Adult, Male, Bangladesh, wa_30, Adolescent, Health, Toxicology and Mutagenesis, Malnutrition, Public Health, Environmental and Occupational Health, Young Adult, Cross-Sectional Studies, Socioeconomic Factors, Prevalence, Humans, wd_105, Female, wa_309, Marriage, wd_100, undernutrition, ever-married women, inequalities, adolescent
Abstract

The objective of this study was to explore the socioeconomic inequalities in undernutrition among ever-married women of reproductive age. We used nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey, 2017–2018. Undernutrition was defined as a body mass index (BMI) of

Published
2022

24. Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

Author

Ewerton Cousin, Bruce B Duncan, Caroline Stein, Kanyin Liane Ong, Theo Vos, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Michael Abdelmasseh, Amir Abdoli, Rami Abd-Rabu, Hassan Abolhassani, Eman Abu-Gharbieh, Manfred Mario Kokou Accrombessi, Qorinah Estiningtyas Sakilah Adnani, Muhammad Sohail Afzal, Gina Agarwal, Krishna K Agrawaal, Marcela Agudelo-Botero, Bright Opoku Ahinkorah, Sajjad Ahmad, Tauseef Ahmad, Keivan Ahmadi, Sepideh Ahmadi, Ali Ahmadi, Ali Ahmed, Yusra Ahmed Salih, Wuraola Akande-Sholabi, Tayyaba Akram, Hanadi Al Hamad, Ziyad Al-Aly, Jacqueline Elizabeth Alcalde-Rabanal, Vahid Alipour, Syed Mohamed Aljunid, Rajaa M Al-Raddadi, Nelson Alvis-Guzman, Saeed Amini, Robert Ancuceanu, Tudorel Andrei, Catalina Liliana Andrei, Ranjit Mohan Anjana, Adnan Ansar, Ippazio Cosimo Antonazzo, Benny Antony, Anayochukwu Edward Anyasodor, Jalal Arabloo, Damian Arizmendi, Benedetta Armocida, Anton A Artamonov, Judie Arulappan, Zahra Aryan, Samaneh Asgari, Tahira Ashraf, Thomas Astell-Burt, Prince Atorkey, Maha Moh'd Wahbi Atout, Martin Amogre Ayanore, Ashish D Badiye, Atif Amin Baig, Mohan Bairwa, Jennifer L Baker, Ovidiu Constantin Baltatu, Palash Chandra Banik, Anthony Barnett, Mark Thomaz Ugliara Barone, Francesco Barone-Adesi, Amadou Barrow, Neeraj Bedi, Rebuma Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Derrick A Bennett, Isabela M Bensenor, David Beran, Akshaya Srikanth Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Ali Bijani, Boris Bikbov, Setognal Birara, Virginia Bodolica, Aime Bonny, Hermann Brenner, Nikolay Ivanovich Briko, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Ismael R Campos-Nonato, Yin Cao, Chao Cao, Ester Cerin, Promit Ananyo Chakraborty, Joht Singh Chandan, Vijay Kumar Chattu, Simiao Chen, Jee-Young Jasmine Choi, Sonali Gajanan Choudhari, Enayet Karim Chowdhury, Dinh-Toi Chu, Barbara Corso, Omid Dadras, Xiaochen Dai, Albertino Antonio Moura Damasceno, Lalit Dandona, Rakhi Dandona, Claudio Alberto Dávila-Cervantes, Jan-Walter De Neve, Edgar Denova-Gutiérrez, Deepak Dhamnetiya, Daniel Diaz, Sanam Ebtehaj, Hisham Atan Edinur, Sahar Eftekharzadeh, Iman El Sayed, Islam Y Elgendy, Muhammed Elhadi, Mohamed A Elmonem, Mohammed Faisaluddin, Umar Farooque, Xiaoqi Feng, Eduarda Fernandes, Florian Fischer, David Flood, Marisa Freitas, Peter Andras Gaal, Mohamed M Gad, Piyada Gaewkhiew, Lemma Getacher, Mansour Ghafourifard, Reza Ghanei Gheshlagh, Ahmad Ghashghaee, Nermin Ghith, Ghozali Ghozali, Paramjit Singh Gill, Ibrahim Abdelmageed Ginawi, Ekaterina Vladimirovna Glushkova, Mahaveer Golechha, Sameer Vali Gopalani, Rafael Alves Guimarães, Rajat Das Gupta, Rajeev Gupta, Vivek Kumar Gupta, Veer Bala Gupta, Sapna Gupta, Tesfa Dejenie Habtewold, Nima Hafezi-Nejad, Rabih Halwani, Asif Hanif, Graeme J Hankey, Shafiul Haque, Ahmed I Hasaballah, Syed Shahzad Hasan, Abdiwahab Hashi, Soheil Hassanipour, Simon I Hay, Khezar Hayat, Mohammad Heidari, Mohammad Bellal Hossain Hossain, Sahadat Hossain, Mostafa Hosseini, Soodabeh Hoveidamanesh, Junjie Huang, Ayesha Humayun, Rabia Hussain, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Kevin S Ikuta, Leeberk Raja Inbaraj, Usman Iqbal, Md Shariful Islam, Sheikh Mohammed Shariful Islam, Rakibul M Islam, Nahlah Elkudssiah Ismail, Gaetano Isola, Ramaiah Itumalla, Masao Iwagami, Ihoghosa Osamuyi Iyamu, Mohammad Ali Jahani, Mihajlo Jakovljevic, Ranil Jayawardena, Ravi Prakash Jha, Oommen John, Jost B Jonas, Tamas Joo, Ali Kabir, Rohollah Kalhor, Ashwin Kamath, Tanuj Kanchan, Himal Kandel, Neeti Kapoor, Gbenga A Kayode, Sewnet Adem Kebede, Pedram Keshavarz, Mohammad Keykhaei, Yousef Saleh Khader, Himanshu Khajuria, Moien AB Khan, Md Nuruzzaman Khan, Maseer Khan, Amir M Khater, Tawfik Ahmed Muthafer Khoja, Jagdish Khubchandani, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Sezer Kisa, Adnan Kisa, Mika Kivimäki, Vladimir Andreevich Korshunov, Oleksii Korzh, Ai Koyanagi, Kewal Krishan, Barthelemy Kuate Defo, G Anil Kumar, Nithin Kumar, Dian Kusuma, Carlo La Vecchia, Ben Lacey, Anders O Larsson, Savita Lasrado, Wei-Chen Lee, Chiachi Bonnie Lee, Paul H Lee, Shaun Wen Huey Lee, Ming-Chieh Li, Stephen S Lim, Lee-Ling Lim, Giancarlo Lucchetti, Azeem Majeed, Ahmad Azam Malik, Borhan Mansouri, Lorenzo Giovanni Mantovani, Santi Martini, Prashant Mathur, Colm McAlinden, Nafiul Mehedi, Teferi Mekonnen, Ritesh G Menezes, Amanual Getnet Mersha, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Andreea Mirica, Erkin M Mirrakhimov, Agha Zeeshan Mirza, Prasanna Mithra, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Ali H Mokdad, Mariam Molokhia, Lorenzo Monasta, Mohammad Ali Moni, Farhad Moradpour, Rahmatollah Moradzadeh, Ebrahim Mostafavi, Ulrich Otto Mueller, Christopher J L Murray, Ahmad Mustafa, Gabriele Nagel, Vinay Nangia, Atta Abbas Naqvi, Biswa Prakash Nayak, Javad Nazari, Rawlance Ndejjo, Ruxandra Irina Negoi, Sandhya Neupane Kandel, Cuong Tat Nguyen, Huong Lan Thi Nguyen, Jean Jacques Noubiap, Christoph Nowak, Bogdan Oancea, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, Temitope T Ojo, Andrew T Olagunju, Obinna E Onwujekwe, Alberto Ortiz, Mayowa O Owolabi, Raffaele Palladino, Songhomitra Panda-Jonas, Seithikurippu R Pandi-Perumal, Shahina Pardhan, Tarang Parekh, Mojtaba Parvizi, Veincent Christian Filipino Pepito, Arokiasamy Perianayagam, Ionela-Roxana Petcu, Manju Pilania, Vivek Podder, Roman V Polibin, Maarten J Postma, Akila Prashant, Navid Rabiee, Mohammad Rabiee, Vafa Rahimi-Movaghar, Muhammad Aziz Rahman, Md. Mosfequr Rahman, Mosiur Rahman, Setyaningrum Rahmawaty, Nazanin Rajai, Pradhum Ram, Juwel Rana, Kamal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Satish Rao, Salman Rawaf, David Laith Rawaf, Lal Rawal, Andre M N Renzaho, Nima Rezaei, Aziz Rezapour, Seyed Mohammad Riahi, Daniela Ribeiro, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Peter Rohloff, Godfrey M Rwegerera, Paul MacDaragh Ryan, Maha Mohamed Saber-Ayad, Siamak Sabour, Basema Saddik, Sahar Saeedi Moghaddam, Amirhossein Sahebkar, Harihar Sahoo, KM Saif-Ur-Rahman, Hamideh Salimzadeh, Mehrnoosh Samaei, Juan Sanabria, Milena M Santric-Milicevic, Brijesh Sathian, Thirunavukkarasu Sathish, Markus P Schlaich, Abdul-Aziz Seidu, Mario Šekerija, Nachimuthu Senthil Kumar, Allen Seylani, Masood Ali Shaikh, Hina Shamshad, Md Shajedur Rahman Shawon, Sara Sheikhbahaei, Jeevan K Shetty, Rahman Shiri, K M Shivakumar, Kerem Shuval, Jasvinder A Singh, Ambrish Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, Ahmad Sofi-Mahmudi, Amin Soheili, Jing Sun, Viktória Szerencsés, Miklós Szócska, Rafael Tabarés-Seisdedos, Hooman Tadbiri, Eyayou Girma Tadesse, Md. Tariqujjaman, Kavumpurathu Raman Thankappan, Rekha Thapar, Nihal Thomas, Binod Timalsina, Ruoyan Tobe-Gai, Marcello Tonelli, Marcos Roberto Tovani-Palone, Bach Xuan Tran, Jaya Prasad Tripathy, Lorainne Tudor Car, Biruk Shalmeno Tusa, Riaz Uddin, Era Upadhyay, Sahel Valadan Tahbaz, Pascual R Valdez, Tommi Juhani Vasankari, Madhur Verma, Victor E Villalobos-Daniel, Sergey Konstantinovitch Vladimirov, Bay Vo, Giang Thu Vu, Rade Vukovic, Yasir Waheed, Richard G Wamai, Andrea Werdecker, Nuwan Darshana Wickramasinghe, Andrea Sylvia Winkler, Befikadu Legesse Wubishet, Xiaoyue Xu, Suowen Xu, Seyed Hossein Yahyazadeh Jabbari, Hiroshi Yatsuya, Sanni Yaya, Taklo Simeneh Yazie Yazie, Siyan Yi, Naohiro Yonemoto, Ismaeel Yunusa, Siddhesh Zadey, Sojib Bin Zaman, Maryam Zamanian, Nelson Zamora, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Alimuddin Zumla, Mohsen Naghavi, Maria Inês Schmidt, Tampere University, Clinical Medicine, QE Econometrics, RS: GSBE other - not theme-related research, Department of Public Health, University of Helsinki, Cousin, E, Duncan, B, Stein, C, Ong, K, Vos, T, Abbafati, C, Abbasi-Kangevari, M, Abdelmasseh, M, Abdoli, A, Abd-Rabu, R, Abolhassani, H, Abu-Gharbieh, E, Accrombessi, M, Adnani, Q, Afzal, M, Agarwal, G, Agrawaal, K, Agudelo-Botero, M, Ahinkorah, B, Ahmad, S, Ahmad, T, Ahmadi, K, Ahmadi, S, Ahmadi, A, Ahmed, A, Ahmed Salih, Y, Akande-Sholabi, W, Akram, T, Al Hamad, H, Al-Aly, Z, Alcalde-Rabanal, J, Alipour, V, Aljunid, S, Al-Raddadi, R, Alvis-Guzman, N, Amini, S, Ancuceanu, R, Andrei, T, Andrei, C, Anjana, R, Ansar, A, Antonazzo, I, Antony, B, Anyasodor, A, Arabloo, J, Arizmendi, D, Armocida, B, Artamonov, A, Arulappan, J, Aryan, Z, Asgari, S, Ashraf, T, Astell-Burt, T, Atorkey, P, Atout, M, Ayanore, M, Badiye, A, Baig, A, Bairwa, M, Baker, J, Baltatu, O, Banik, P, Barnett, A, Barone, M, Barone-Adesi, F, Barrow, A, Bedi, N, Belete, R, Belgaumi, U, Bell, A, Bennett, D, Bensenor, I, Beran, D, Bhagavathula, A, Bhaskar, S, Bhattacharyya, K, Bhojaraja, V, Bijani, A, Bikbov, B, Birara, S, Bodolica, V, Bonny, A, Brenner, H, Briko, N, Butt, Z, Caetano dos Santos, F, Camera, L, Campos-Nonato, I, Cao, Y, Cao, C, Cerin, E, Chakraborty, P, Chandan, J, Chattu, V, Chen, S, Choi, J, Choudhari, S, Chowdhury, E, Chu, D, Corso, B, Dadras, O, Dai, X, Damasceno, A, Dandona, L, Dandona, R, Davila-Cervantes, C, De Neve, J, Denova-Gutierrez, E, Dhamnetiya, D, Diaz, D, Ebtehaj, S, Edinur, H, Eftekharzadeh, S, El Sayed, I, Elgendy, I, Elhadi, M, Elmonem, M, Faisaluddin, M, Farooque, U, Feng, X, Fernandes, E, Fischer, F, Flood, D, Freitas, M, Gaal, P, Gad, M, Gaewkhiew, P, Getacher, L, Ghafourifard, M, Ghanei Gheshlagh, R, Ghashghaee, A, Ghith, N, Ghozali, G, Gill, P, Ginawi, I, Glushkova, E, Golechha, M, Gopalani, S, Guimaraes, R, Gupta, R, Gupta, V, Gupta, S, Habtewold, T, Hafezi-Nejad, N, Halwani, R, Hanif, A, Hankey, G, Haque, S, Hasaballah, A, Hasan, S, Hashi, A, Hassanipour, S, Hay, S, Hayat, K, Heidari, M, Hossain, M, Hossain, S, Hosseini, M, Hoveidamanesh, S, Huang, J, Humayun, A, Hussain, R, Hwang, B, Ibitoye, S, Ikuta, K, Inbaraj, L, Iqbal, U, Islam, M, Islam, S, Islam, R, Ismail, N, Isola, G, Itumalla, R, Iwagami, M, Iyamu, I, Jahani, M, Jakovljevic, M, Jayawardena, R, Jha, R, John, O, Jonas, J, Joo, T, Kabir, A, Kalhor, R, Kamath, A, Kanchan, T, Kandel, H, Kapoor, N, Kayode, G, Kebede, S, Keshavarz, P, Keykhaei, M, Khader, Y, Khajuria, H, Khan, M, Khater, A, Khoja, T, Khubchandani, J, Kim, M, Kim, Y, Kimokoti, R, Kisa, S, Kisa, A, Kivimaki, M, Korshunov, V, Korzh, O, Koyanagi, A, Krishan, K, Kuate Defo, B, Kumar, G, Kumar, N, Kusuma, D, La Vecchia, C, Lacey, B, Larsson, A, Lasrado, S, Lee, W, Lee, C, Lee, P, Lee, S, Li, M, Lim, S, Lim, L, Lucchetti, G, Majeed, A, Malik, A, Mansouri, B, Mantovani, L, Martini, S, Mathur, P, Mcalinden, C, Mehedi, N, Mekonnen, T, Menezes, R, Mersha, A, Miao Jonasson, J, Miazgowski, T, Michalek, I, Mirica, A, Mirrakhimov, E, Mirza, A, Mithra, P, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, A, Mokdad, A, Molokhia, M, Monasta, L, Moni, M, Moradpour, F, Moradzadeh, R, Mostafavi, E, Mueller, U, Murray, C, Mustafa, A, Nagel, G, Nangia, V, Naqvi, A, Nayak, B, Nazari, J, Ndejjo, R, Negoi, R, Neupane Kandel, S, Nguyen, C, Nguyen, H, Noubiap, J, Nowak, C, Oancea, B, Odukoya, O, Oguntade, A, Ojo, T, Olagunju, A, Onwujekwe, O, Ortiz, A, Owolabi, M, Palladino, R, Panda-Jonas, S, Pandi-Perumal, S, Pardhan, S, Parekh, T, Parvizi, M, Pepito, V, Perianayagam, A, Petcu, I, Pilania, M, Podder, V, Polibin, R, Postma, M, Prashant, A, Rabiee, N, Rabiee, M, Rahimi-Movaghar, V, Rahman, M, Rahmawaty, S, Rajai, N, Ram, P, Rana, J, Ranabhat, K, Ranasinghe, P, Rao, C, Rao, S, Rawaf, S, Rawaf, D, Rawal, L, Renzaho, A, Rezaei, N, Rezapour, A, Riahi, S, Ribeiro, D, Rodriguez, J, Roever, L, Rohloff, P, Rwegerera, G, Ryan, P, Saber-Ayad, M, Sabour, S, Saddik, B, Saeedi Moghaddam, S, Sahebkar, A, Sahoo, H, Saif-Ur-Rahman, K, Salimzadeh, H, Samaei, M, Sanabria, J, Santric-Milicevic, M, Sathian, B, Sathish, T, Schlaich, M, Seidu, A, Sekerija, M, Senthil Kumar, N, Seylani, A, Shaikh, M, Shamshad, H, Shawon, M, Sheikhbahaei, S, Shetty, J, Shiri, R, Shivakumar, K, Shuval, K, Singh, J, Singh, A, Skryabin, V, Skryabina, A, Sofi-Mahmudi, A, Soheili, A, Sun, J, Szerencses, V, Szocska, M, Tabares-Seisdedos, R, Tadbiri, H, Tadesse, E, Tariqujjaman, M, Thankappan, K, Thapar, R, Thomas, N, Timalsina, B, Tobe-Gai, R, Tonelli, M, Tovani-Palone, M, Tran, B, Tripathy, J, Tudor Car, L, Tusa, B, Uddin, R, Upadhyay, E, Valadan Tahbaz, S, Valdez, P, Vasankari, T, Verma, M, Villalobos-Daniel, V, Vladimirov, S, Vo, B, Vu, G, Vukovic, R, Waheed, Y, Wamai, R, Werdecker, A, Wickramasinghe, N, Winkler, A, Wubishet, B, Xu, X, Xu, S, Yahyazadeh Jabbari, S, Yatsuya, H, Yaya, S, Yazie, T, Yi, S, Yonemoto, N, Yunusa, I, Zadey, S, Zaman, S, Zamanian, M, Zamora, N, Zastrozhin, M, Zastrozhina, A, Zhang, Z, Zhong, C, Zmaili, M, Zumla, A, Naghavi, M, Schmidt, M, GBD 2019 Diabetes Mortality Collaborators, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Cousin, E., Duncan, B. B., Stein, C., Ong, K. L., Vos, T., Abbafati, C., Abbasi-Kangevari, M., Abdelmasseh, M., Abdoli, A., Abd-Rabu, R., Abolhassani, H., Abu-Gharbieh, E., Accrombessi, M. M. K., Adnani, Q. E. S., Afzal, M. S., Agarwal, G., Agrawaal, K. K., Agudelo-Botero, M., Ahinkorah, B. O., Ahmad, S., Ahmad, T., Ahmadi, K., Ahmadi, S., Ahmadi, A., Ahmed, A., Ahmed Salih, Y., Akande-Sholabi, W., Akram, T., Al Hamad, H., Al-Aly, Z., Alcalde-Rabanal, J. E., Alipour, V., Aljunid, S. M., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Ancuceanu, R., Andrei, T., Andrei, C. L., Anjana, R. M., Ansar, A., Antonazzo, I. C., Antony, B., Anyasodor, A. E., Arabloo, J., Arizmendi, D., Armocida, B., Artamonov, A. A., Arulappan, J., Aryan, Z., Asgari, S., Ashraf, T., Astell-Burt, T., Atorkey, P., Atout, M. M. W., Ayanore, M. A., Badiye, A. D., Baig, A. A., Bairwa, M., Baker, J. L., Baltatu, O. C., Banik, P. C., Barnett, A., Barone, M. T. U., Barone-Adesi, F., Barrow, A., Bedi, N., Belete, R., Belgaumi, U. I., Bell, A. W., Bennett, D. A., Bensenor, I. M., Beran, D., Bhagavathula, A. S., Bhaskar, S., Bhattacharyya, K., Bhojaraja, V. S., Bijani, A., Bikbov, B., Birara, S., Bodolica, V., Bonny, A., Brenner, H., Briko, N. I., Butt, Z. A., Caetano dos Santos, F. L., Camera, L. A., Campos-Nonato, I. R., Cao, Y., Cao, C., Cerin, E., Chakraborty, P. A., Chandan, J. S., Chattu, V. K., Chen, S., Choi, J. -Y. J., Choudhari, S. G., Chowdhury, E. K., Chu, D. -T., Corso, B., Dadras, O., Dai, X., Damasceno, A. A. M., Dandona, L., Dandona, R., Davila-Cervantes, C. A., De Neve, J. -W., Denova-Gutierrez, E., Dhamnetiya, D., Diaz, D., Ebtehaj, S., Edinur, H. A., Eftekharzadeh, S., El Sayed, I., Elgendy, I. Y., Elhadi, M., Elmonem, M. A., Faisaluddin, M., Farooque, U., Feng, X., Fernandes, E., Fischer, F., Flood, D., Freitas, M., Gaal, P. A., Gad, M. M., Gaewkhiew, P., Getacher, L., Ghafourifard, M., Ghanei Gheshlagh, R., Ghashghaee, A., Ghith, N., Ghozali, G., Gill, P. S., Ginawi, I. A., Glushkova, E. V., Golechha, M., Gopalani, S. V., Guimaraes, R. A., Gupta, R. D., Gupta, R., Gupta, V. K., Gupta, V. B., Gupta, S., Habtewold, T. D., Hafezi-Nejad, N., Halwani, R., Hanif, A., Hankey, G. J., Haque, S., Hasaballah, A. I., Hasan, S. S., Hashi, A., Hassanipour, S., Hay, S. I., Hayat, K., Heidari, M., Hossain, M. B. H., Hossain, S., Hosseini, M., Hoveidamanesh, S., Huang, J., Humayun, A., Hussain, R., Hwang, B. -F., Ibitoye, S. E., Ikuta, K. S., Inbaraj, L. R., Iqbal, U., Islam, M. S., Islam, S. M. S., Islam, R. M., Ismail, N. E., Isola, G., Itumalla, R., Iwagami, M., Iyamu, I. O., Jahani, M. A., Jakovljevic, M., Jayawardena, R., Jha, R. P., John, O., Jonas, J. B., Joo, T., Kabir, A., Kalhor, R., Kamath, A., Kanchan, T., Kandel, H., Kapoor, N., Kayode, G. A., Kebede, S. A., Keshavarz, P., Keykhaei, M., Khader, Y. S., Khajuria, H., Khan, M. A., Khan, M. N., Khan, M., Khater, A. M., Khoja, T. A. M., Khubchandani, J., Kim, M. S., Kim, Y. J., Kimokoti, R. W., Kisa, S., Kisa, A., Kivimaki, M., Korshunov, V. A., Korzh, O., Koyanagi, A., Krishan, K., Kuate Defo, B., Kumar, G. A., Kumar, N., Kusuma, D., La Vecchia, C., Lacey, B., Larsson, A. O., Lasrado, S., Lee, W. -C., Lee, C. B., Lee, P. H., Lee, S. W. H., Li, M. -C., Lim, S. S., Lim, L. -L., Lucchetti, G., Majeed, A., Malik, A. A., Mansouri, B., Mantovani, L. G., Martini, S., Mathur, P., Mcalinden, C., Mehedi, N., Mekonnen, T., Menezes, R. G., Mersha, A. G., Miao Jonasson, J., Miazgowski, T., Michalek, I. M., Mirica, A., Mirrakhimov, E. M., Mirza, A. Z., Mithra, P., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, A., Mokdad, A. H., Molokhia, M., Monasta, L., Moni, M. A., Moradpour, F., Moradzadeh, R., Mostafavi, E., Mueller, U. O., Murray, C. J. L., Mustafa, A., Nagel, G., Nangia, V., Naqvi, A. A., Nayak, B. P., Nazari, J., Ndejjo, R., Negoi, R. I., Neupane Kandel, S., Nguyen, C. T., Nguyen, H. L. T., Noubiap, J. J., Nowak, C., Oancea, B., Odukoya, O. O., Oguntade, A. S., Ojo, T. T., Olagunju, A. T., Onwujekwe, O. E., Ortiz, A., Owolabi, M. O., Palladino, R., Panda-Jonas, S., Pandi-Perumal, S. R., Pardhan, S., Parekh, T., Parvizi, M., Pepito, V. C. F., Perianayagam, A., Petcu, I. -R., Pilania, M., Podder, V., Polibin, R. V., Postma, M. J., Prashant, A., Rabiee, N., Rabiee, M., Rahimi-Movaghar, V., Rahman, M. A., Rahman, M. M., Rahman, M., Rahmawaty, S., Rajai, N., Ram, P., Rana, J., Ranabhat, K., Ranasinghe, P., Rao, C. R., Rao, S., Rawaf, S., Rawaf, D. L., Rawal, L., Renzaho, A. M. N., Rezaei, N., Rezapour, A., Riahi, S. M., Ribeiro, D., Rodriguez, J. A. B., Roever, L., Rohloff, P., Rwegerera, G. M., Ryan, P. M., Saber-Ayad, M. M., Sabour, S., Saddik, B., Saeedi Moghaddam, S., Sahebkar, A., Sahoo, H., Saif-Ur-Rahman, K. M., Salimzadeh, H., Samaei, M., Sanabria, J., Santric-Milicevic, M. M., Sathian, B., Sathish, T., Schlaich, M. P., Seidu, A. -A., Sekerija, M., Senthil Kumar, N., Seylani, A., Shaikh, M. A., Shamshad, H., Shawon, M. S. R., Sheikhbahaei, S., Shetty, J. K., Shiri, R., Shivakumar, K. M., Shuval, K., Singh, J. A., Singh, A., Skryabin, V. Y., Skryabina, A. A., Sofi-Mahmudi, A., Soheili, A., Sun, J., Szerencses, V., Szocska, M., Tabares-Seisdedos, R., Tadbiri, H., Tadesse, E. G., Tariqujjaman, M., Thankappan, K. R., Thapar, R., Thomas, N., Timalsina, B., Tobe-Gai, R., Tonelli, M., Tovani-Palone, M. R., Tran, B. X., Tripathy, J. P., Tudor Car, L., Tusa, B. S., Uddin, R., Upadhyay, E., Valadan Tahbaz, S., Valdez, P. R., Vasankari, T. J., Verma, M., Villalobos-Daniel, V. E., Vladimirov, S. K., Vo, B., Vu, G. T., Vukovic, R., Waheed, Y., Wamai, R. G., Werdecker, A., Wickramasinghe, N. D., Winkler, A. S., Wubishet, B. L., Xu, X., Xu, S., Yahyazadeh Jabbari, S. H., Yatsuya, H., Yaya, S., Yazie, T. S. Y., Yi, S., Yonemoto, N., Yunusa, I., Zadey, S., Zaman, S. B., Zamanian, M., Zamora, N., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z. -J., Zhong, C., Zmaili, M., Zumla, A., Naghavi, M., Schmidt, M. I., Collaborators, GBD 2019 Diabetes Mortality, and Lacey, BWH

Subjects
Adult, Endocrinology, Diabetes and Metabolism, CHILDHOOD, universal health coverage, Global Health, 3121 Internal medicine, Global Burden of Disease, 1117 Public Health and Health Services, Endocrinology, SDG 3 - Good Health and Well-being, Risk Factors, RA0421, Internal Medicine, Humans, Diabetes mortality, diabetes, mortality, global burden of disease, under 25 years, COHORT, health care services, COMPLICATIONS, CHALLENGES, Diabetes, Mortality trends, Age-specific diabetes, 1103 Clinical Sciences, Public Health, Global Health, Social Medicine and Epidemiology, BRAZIL, Type I Diabetes, INSULIN, 3142 Public health care science, environmental and occupational health, the Socio-demographic Index, Treatment, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, 1101 Medical Biochemistry and Metabolomics, diabete, 3121 General medicine, internal medicine and other clinical medicine, ACCESS, RA, RC
Abstract

Background:Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods:We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings:In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation:Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation.

Published
2022

25. Effectiveness, Safety and Economic Viability of Daycare Versus Usual Care Management of Severe Pneumonia with or Without Malnutrition in Children Using the Existing Health System of Bangladesh: A Cluster Randomized Controlled Trial

Author

Md Nur Haque Alam, Abu S Faruque, Hasan Ashraf, Mohammod Jobayer Chisti, Tahmeed Ahmed, Marufa Sultana, Khalequ Zaman, Shajahan Ali, Shahnawaz Ahmed, Sabiha Nasrin, Md. Tariqujjaman, Ehsanul Haque, Ruhul Amin, Abid Hossain Mollah, Lutful Kabir, Mohammod Shahidullah, Wahida Khanam, Khaleda Islam, Minjoon Kim, Trevor Duke, Niklaus Gyr, and George J. Fuchs

Subjects
History, Polymers and Plastics, Business and International Management, Industrial and Manufacturing Engineering
Published
2022

26. Geographical variations of food insecurity and its associated factors in Bangladesh: Evidence from pooled data of seven cross-sectional surveys

Author

Md. Tariqujjaman, Mahfuzur Rahman, Kinley Wangdi, Gobinda Karmakar, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Multidisciplinary
Abstract

Food insecurity has multiple negative effects on maternal and child health and nutritional outcomes. There is a dearth of up-to-date evidence on the prevalence of food insecurity in Bangladesh based on geographical variations. We investigated the prevalence of food insecurity based on geographical variations and its associated factors. We pooled data from seven cross-sectional surveys conducted in 15,009 households from March 2015 to May 2018. This study was a part of the evaluation of the Maternal Infant Young Child Nutrition Phase 2 programme implemented by BRAC, one of the largest international non-governmental organizations located in Bangladesh that covered rural areas in 26 districts and two urban slums in Dhaka, Bangladesh. We used Household Food Insecurity Access Scale (a widely used scale to measure household food insecurity) to estimate the food insecurity status from the data collected through a face-to-face interview using a structured questionnaire. Hot spot analysis was conducted using the Getis-Ord Gi* statistic. The multiple logistic regression model was applied to explore the associated factors of food insecurity. The food insecurity hotspots were in the northwestern, central-southwestern, and coastal districts of Bangladesh. The overall prevalence of mild, moderate, and severe food insecurity were 12.7%, 13.8%, and 3.5%, respectively. In the adjusted model, household heads and caregivers of children with five or more years of schooling had respectively 42% (adjusted odds ratio (AOR): 0.58, 95% confidence interval (CI): 0.52, 0.64) and 46% (AOR: 0.54; 95% CI: 0.49, 0.61) less likelihood to suffer from food insecurity. Households in the middle (AOR: 0.58, 95% CI: 0.52, 0.65) and rich (AOR: 0.32, 95% CI: 0.28, 0.36) wealth status had lower odds of food insecurity. Food insecurity is widely spread in rural districts of Bangladesh and the degree of vulnerability is higher among the households of the northwestern, central-southwestern, and coastal areas of Bangladesh. Comprehensive interventions including strategies for poverty reduction and education for all might be effective to reduce food insecurity at rural households in Bangladesh.

Published
2021

27. Household Food Insecurity and Unavailability of Toilet Facility Contribute to Adverse Health Outcomes of Under-five Children in Bangladesh: A Cross-sectional Study

Author

Tahmeed Ahmed, Mohammad Ashikur Rahman, Md. Fakhar Uddin, Haribondhu Sarma, Gobinda Karmakar, Matthew Kelly, Darren J. Gray, Mohammad Ashraful Islam, Mahfuzur Rahman, and Md. Tariqujjaman

Subjects
Food insecurity, Cross-sectional study, business.industry, Under five children, Environmental health, Medicine, Toilet Facility, Unavailability, Health outcomes, business
Abstract

BackgroundDespite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Limited studies have sought to understand the relationship of household FI and sanitation, separately and in combination, with child morbidity. This paper aimed to assess the effect of FI and unimproved toilet facility of households on adverse health outcomes of children less than five years of age in Bangladesh.MethodsWe used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in Bangladesh. The study population included children aged 6-59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders. ResultsA total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95).ConclusionsOur study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is important to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.

Published
2021

28. Household food insecurity and unimproved toilet facilities associate with child morbidity: evidence from a cross-sectional study in Bangladesh

Author

Mohammad Ashraful Islam, Mahfuzur Rahman, Md. Fakhar Uddin, Md. Tariqujjaman, Gobinda Karmakar, Mohammad Ashikur Rahman, Matthew Kelly, Darren Gray, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Bangladesh, Food Insecurity, Cross-Sectional Studies, Public Health, Environmental and Occupational Health, Prevalence, Humans, Infant, Mothers, Female, Toilet Facilities, Child
Abstract

Background Despite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Evidence regarding the consequencs of household FI and poor sanitation on child morbidity is scarce. This study aimed to understand the association of FI and unimproved toilet facility with morbidity status of under-5 children in Bangladesh. Methods We used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in 9 districts of Bangladesh. The study population included children aged 6–59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders. Results A total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95). Conclusions Our study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is recommended to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.

Published
2021

29. Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis

Author

Sabiha Nasrin, Md. Tariqujjaman, Marufa Sultana, Rifat A. Zaman, Shahjahan Ali, Mohammod J. Chisti, Abu S. G. Faruque, Tahmeed Ahmed, George J. Fuchs, Niklaus Gyr, and Nur H. Alam

Subjects
Community-Acquired Infections, Male, Bangladesh, Multidisciplinary, Case-Control Studies, Humans, Infant, Female, Pneumonia, Prospective Studies, Child, Growth Disorders
Abstract

Background Pneumonia is the leading cause of death in children globally with the majority of these deaths observed in resource-limited settings. Globally, the annual incidence of clinical pneumonia in under-five children is approximately 152 million, mostly in the low- and middle-income countries. Of these, 8.7% progressed to severe pneumonia requiring hospitalization. However, data to predict children at the greatest risk to develop severe pneumonia from pneumonia are limited. Method Secondary data analysis was performed after extracting relevant data from a prospective cluster randomized controlled clinical trial; children of either sex, aged two months to five years with pneumonia or severe pneumonia acquired in the community were enrolled over a period of three years in 16 clusters in urban Dhaka city. Results The analysis comprised of 2,597 children aged 2–59 months. Of these, 904 and 1693 were categorized as pneumonia (controls) and severe pneumonia (cases), respectively based on WHO criteria. The median age of children was 9.2 months (inter quartile range, 5.1–17.1) and 1,576 (60%) were male. After adjustment for covariates, children with temperature ≥38°C, duration of illness ≥3 days, male sex, received prior medical care and severe stunting showed a significantly increased likelihood of developing severe pneumonia compared to those with pneumonia. Severe pneumonia in children occurred more often in older children who presented commonly from wealthy quintile families, and who often sought care from private facilities in urban settings. Conclusion and recommendation Male sex, longer duration of illness, fever, received prior medical care, and severe stunting were significantly associated with development of WHO-defined severe childhood pneumonia in our population. The results of this study may help to develop interventions target to reduce childhood morbidity and mortality of children suffering from severe pneumonia.

Published
2021

30. Between and Within-Country Variations in Infant and Young Child Feeding Practices in South Asia

Author

Md. Tariqujjaman, Md. Mehedi Hasan, Mustafa Mahfuz, Tahmeed Ahmed, and Muttaquina Hossain

Subjects
Bangladesh, Breast Feeding, infant and young child feeding practices, South Asia, variations, sociodemographic subgroups, Health, Toxicology and Mutagenesis, Public Health, Environmental and Occupational Health, Humans, Infant, Mothers, Female, Feeding Behavior, Child, Diet
Abstract

This study aimed to explore variations in Infant and Young Child Feeding (IYCF) practices between different South Asian Countries (SACs) and within their sociodemographic characteristics including place of residence, mother age, mother education, child sex, and wealth quintiles within the SACs. We extracted 0–23 months age children’s data from the nationally representative survey of Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. Among all SACs, the early initiation of breastfeeding (EIBF) practice was 45.4% with the highest prevalence in the Maldives (68.2%) and the lowest prevalence in Pakistan (20.8%). Exclusive breastfeeding (EBF) practice was 53.9% with the highest prevalence in Nepal (67%) and the lowest prevalence in Afghanistan (42%). Only 13% of children had a minimum acceptable diet (MAD), with the highest prevalence in the Maldives (52%) and the lowest prevalence in India (11%). We found higher IYCF practices among the mothers with secondary or higher levels of education (EIBF: 47.0% vs. 43.6%; EBF: 55.5% vs. 52.0%; MAD: 15.3% vs. 10.0%), urban mothers (MAD: 15.6% vs. 11.8%), and mothers from the richest households (MAD: 17.6% vs. 8.6%) compared to the mothers with no formal education or below secondary level education, rural mothers and mothers from the poorest households, respectively. Mothers from the poorest households had better EIBF, EBF, and continued breastfeeding at 1-year (CBF) practices compared to the mothers from the richest households (EIBF: 44.2% vs. 40.7%; EBF: 54.8% vs. 53.0%; CBF: 86.3% vs. 77.8%). Poor IYCF practices were most prevalent in Afghanistan, Pakistan, and India.

Published
2022

31. Association between Mother’s Education and Infant and Young Child Feeding Practices in South Asia

Author

Md. Tariqujjaman, Md. Mehedi Hasan, Mustafa Mahfuz, Muttaquina Hossain, and Tahmeed Ahmed

Subjects
Breast Feeding, Nutrition and Dietetics, infant and young child feeding, mother’s education, South Asia, Iron, Humans, India, Infant, Mothers, Female, Feeding Behavior, Child, Infant Nutritional Physiological Phenomena, Food Science
Abstract

The association between mother’s education and the World Health Organization’s (WHO’s) eight Infant and Young Child Feeding (IYCF) core indicators has yet to be explored in South Asia (SA). This study aimed to explore the association between mother’s education and the WHO’s eight IYCF core indicators in SA. We analyzed data from the most recent nationally representative Demographic and Health Surveys of six South Asian Countries (SACs)—Afghanistan, Bangladesh, India, Maldives, Nepal, and Pakistan. We found significantly higher odds (adjusted odds ratio, AOR, 1.13 to 1.47) among mothers who completed secondary or higher education than among mothers with education levels below secondary for the following seven IYCF indicators: early initiation of breastfeeding (EIBF), exclusive breastfeeding under 6 months (EBF), the introduction of solid, semisolid or soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich or iron-fortified foods (CIRF); the exception was for the indicator of continued breastfeeding at one year. Country-specific analyses revealed significantly higher odds in EIBF (AOR 1.14; 95% CI: 1.11, 1.18) and EBF (AOR 1.27; 95% CI: 1.19, 1.34) among mothers with secondary or higher education levels in India. In contrast, the odds were lower for EIBF in Bangladesh and for EBF in Pakistan among mothers with secondary or higher education levels. For country-specific analyses for complementary feeding indicators such as ISSSF, MDD, MMF, MAD, and CIRF, significantly higher odds (AOR, 1.15 to 2.34) were also observed among mothers with secondary or higher education levels. These findings demonstrate a strong positive association between mother’s education and IYCF indicators. Strengthening national policies to educate women at least to the secondary level in SACs might be a cost-effective intervention for improving IYCF practices.

Published
2022

32. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study

Author

Gregory A. Roth, George A. Mensah, Catherine O. Johnson, Giovanni Addolorato, Enrico Ammirati, Larry M. Baddour, Noël C. Barengo, Andrea Z. Beaton, Emelia J. Benjamin, Catherine P. Benziger, Aimé Bonny, Michael Brauer, Marianne Brodmann, Thomas J. Cahill, Jonathan Carapetis, Alberico L. Catapano, Sumeet S. Chugh, Leslie T. Cooper, Josef Coresh, Michael Criqui, Nicole DeCleene, Kim A. Eagle, Sophia Emmons-Bell, Valery L. Feigin, Joaquim Fernández-Solà, Gerry Fowkes, Emmanuela Gakidou, Scott M. Grundy, Feng J. He, George Howard, Frank Hu, Lesley Inker, Ganesan Karthikeyan, Nicholas Kassebaum, Walter Koroshetz, Carl Lavie, Donald Lloyd-Jones, Hong S. Lu, Antonio Mirijello, Awoke Misganaw Temesgen, Ali Mokdad, Andrew E. Moran, Paul Muntner, Jagat Narula, Bruce Neal, Mpiko Ntsekhe, Glaucia Moraes de Oliveira, Catherine Otto, Mayowa Owolabi, Michael Pratt, Sanjay Rajagopalan, Marissa Reitsma, Antonio Luiz P. Ribeiro, Nancy Rigotti, Anthony Rodgers, Craig Sable, Saate Shakil, Karen Sliwa-Hahnle, Benjamin Stark, Johan Sundström, Patrick Timpel, Imad M. Tleyjeh, Marco Valgimigli, Theo Vos, Paul K. Whelton, Magdi Yacoub, Liesl Zuhlke, Christopher Murray, Valentin Fuster, Noel C. Barengo, Andrea Beaton, Aime Bonny, Jonathan R. Carapetis, Sumeet Chugh, Michael H. Criqui, Nicole K. DeCleene, Joaquim Fernández-Sola, F. Gerry R. Fowkes, Nicholas J. Kassebaum, Walter J. Koroshetz, Awoke T. Misganaw, Ali H. Mokdad, Gláucia M.M. Oliveira, Catherine M. Otto, Mayowa O. Owolabi, Marissa B. Reitsma, Nancy A. Rigotti, Craig A. Sable, Saate S. Shakil, Karen Sliwa, Benjamin A. Stark, Imad I. Tleyjeh, Liesl J. Zuhlke, Mohsen Abbasi-Kangevari, Alireza Abdi, Aidin Abedi, Victor Aboyans, Woldu A. Abrha, Eman Abu-Gharbieh, Abdelrahman I. Abushouk, Dilaram Acharya, Tim Adair, Oladimeji M. Adebayo, Zanfina Ademi, Shailesh M. Advani, Khashayar Afshari, Ashkan Afshin, Gina Agarwal, Pradyumna Agasthi, Sohail Ahmad, Sepideh Ahmadi, Muktar B. Ahmed, Budi Aji, Yonas Akalu, Wuraola Akande-Sholabi, Addis Aklilu, Chisom J. Akunna, Fares Alahdab, Ayman Al-Eyadhy, Khalid F. Alhabib, Sheikh M. Alif, Vahid Alipour, Syed M. Aljunid, François Alla, Amir Almasi-Hashiani, Sami Almustanyir, Rajaa M. Al-Raddadi, Adeladza K. Amegah, Saeed Amini, Arya Aminorroaya, Hubert Amu, Dickson A. Amugsi, Robert Ancuceanu, Deanna Anderlini, Tudorel Andrei, Catalina Liliana Andrei, Alireza Ansari-Moghaddam, Zelalem A. Anteneh, Ippazio Cosimo Antonazzo, Benny Antony, Razique Anwer, Lambert T. Appiah, Jalal Arabloo, Johan Ärnlöv, Kurnia D. Artanti, Zerihun Ataro, Marcel Ausloos, Leticia Avila-Burgos, Asma T. Awan, Mamaru A. Awoke, Henok T. Ayele, Muluken A. Ayza, Samad Azari, Darshan B. B, Nafiseh Baheiraei, Atif A. Baig, Ahad Bakhtiari, Maciej Banach, Palash C. Banik, Emerson A. Baptista, Miguel A. Barboza, Lingkan Barua, Sanjay Basu, Neeraj Bedi, Yannick Béjot, Derrick A. Bennett, Isabela M. Bensenor, Adam E. Berman, Yihienew M. Bezabih, Akshaya S. Bhagavathula, Sonu Bhaskar, Krittika Bhattacharyya, Ali Bijani, Boris Bikbov, Mulugeta M. Birhanu, Archith Boloor, Luisa C. Brant, Hermann Brenner, Nikolay I. Briko, Zahid A. Butt, Florentino Luciano Caetano dos Santos, Leah E. Cahill, Lucero Cahuana-Hurtado, Luis A. Cámera, Ismael R. Campos-Nonato, Carlos Cantu-Brito, Josip Car, Juan J. Carrero, Felix Carvalho, Carlos A. Castañeda-Orjuela, Ferrán Catalá-López, Ester Cerin, Jaykaran Charan, Vijay Kumar Chattu, Simiao Chen, Ken L. Chin, Jee-Young J. Choi, Dinh-Toi Chu, Sheng-Chia Chung, Massimo Cirillo, Sean Coffey, Sara Conti, Vera M. Costa, David K. Cundiff, Omid Dadras, Baye Dagnew, Xiaochen Dai, Albertino A.M. Damasceno, Lalit Dandona, Rakhi Dandona, Kairat Davletov, Vanessa De la Cruz-Góngora, Fernando P. De la Hoz, Jan-Walter De Neve, Edgar Denova-Gutiérrez, Meseret Derbew Molla, Behailu T. Derseh, Rupak Desai, Günther Deuschl, Samath D. Dharmaratne, Meghnath Dhimal, Raja Ram Dhungana, Mostafa Dianatinasab, Daniel Diaz, Shirin Djalalinia, Klara Dokova, Abdel Douiri, Bruce B. Duncan, Andre R. Duraes, Arielle W. Eagan, Sanam Ebtehaj, Aziz Eftekhari, Sahar Eftekharzadeh, Michael Ekholuenetale, Nevine El Nahas, Islam Y. Elgendy, Muhammed Elhadi, Shaimaa I. El-Jaafary, Sadaf Esteghamati, Atkilt E. Etisso, Oghenowede Eyawo, Ibtihal Fadhil, Emerito Jose A. Faraon, Pawan S. Faris, Medhat Farwati, Farshad Farzadfar, Eduarda Fernandes, Carlota Fernandez Prendes, Pietro Ferrara, Irina Filip, Florian Fischer, David Flood, Takeshi Fukumoto, Mohamed M. Gad, Shilpa Gaidhane, Morsaleh Ganji, Jalaj Garg, Abadi K. Gebre, Birhan G. Gebregiorgis, Kidane Z. Gebregzabiher, Gebreamlak G. Gebremeskel, Lemma Getacher, Abera Getachew Obsa, Alireza Ghajar, Ahmad Ghashghaee, Nermin Ghith, Simona Giampaoli, Syed Amir Gilani, Paramjit S. Gill, Richard F. Gillum, Ekaterina V. Glushkova, Elena V. Gnedovskaya, Mahaveer Golechha, Kebebe B. Gonfa, Amir Hossein Goudarzian, Alessandra C. Goulart, Jenny S. Guadamuz, Avirup Guha, Yuming Guo, Rajeev Gupta, Vladimir Hachinski, Nima Hafezi-Nejad, Teklehaimanot G. Haile, Randah R. Hamadeh, Samer Hamidi, Graeme J. Hankey, Arief Hargono, Risky K. Hartono, Maryam Hashemian, Abdiwahab Hashi, Shoaib Hassan, Hamid Y. Hassen, Rasmus J. Havmoeller, Simon I. Hay, Khezar Hayat, Golnaz Heidari, Claudiu Herteliu, Ramesh Holla, Mostafa Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Ayesha Humayun, Ivo Iavicoli, Charles U. Ibeneme, Segun E. Ibitoye, Olayinka S. Ilesanmi, Irena M. Ilic, Milena D. Ilic, Usman Iqbal, Seyed Sina N. Irvani, Sheikh Mohammed Shariful Islam, Rakibul M. Islam, Hiroyasu Iso, Masao Iwagami, Vardhmaan Jain, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Ranil Jayawardena, Panniyammakal Jeemon, Ravi P. Jha, Jost B. Jonas, Jitendra Jonnagaddala, Farahnaz Joukar, Jacek J. Jozwiak, Mikk Jürisson, Ali Kabir, Tanvir Kahlon, Rizwan Kalani, Rohollah Kalhor, Ashwin Kamath, Ibrahim Kamel, Himal Kandel, Amit Kandel, André Karch, Ayele Semachew Kasa, Patrick D.M.C. Katoto, Gbenga A. Kayode, Yousef S. Khader, Mohammad Khammarnia, Muhammad S. Khan, Md Nuruzzaman Khan, Maseer Khan, Ejaz A. Khan, Khaled Khatab, Gulam M.A. Kibria, Yun Jin Kim, Gyu Ri Kim, Ruth W. Kimokoti, Sezer Kisa, Adnan Kisa, Mika Kivimäki, Dhaval Kolte, Ali Koolivand, Vladimir A. Korshunov, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Vaman Kulkarni, G. Anil Kumar, Nithin Kumar, Om P. Kurmi, Dian Kusuma, Gene F. Kwan, Carlo La Vecchia, Ben Lacey, Tea Lallukka, Qing Lan, Savita Lasrado, Zohra S. Lassi, Paolo Lauriola, Wayne R. Lawrence, Avula Laxmaiah, Kate E. LeGrand, Ming-Chieh Li, Bingyu Li, Shanshan Li, Stephen S. Lim, Lee-Ling Lim, Hualiang Lin, Ziqiang Lin, Ro-Ting Lin, Xuefeng Liu, Alan D. Lopez, Stefan Lorkowski, Paulo A. Lotufo, Alessandra Lugo, Nirmal K. M, Fabiana Madotto, Morteza Mahmoudi, Azeem Majeed, Reza Malekzadeh, Ahmad A. Malik, Abdullah A. Mamun, Navid Manafi, Mohammad Ali Mansournia, Lorenzo G. Mantovani, Santi Martini, Manu R. Mathur, Giampiero Mazzaglia, Suresh Mehata, Man Mohan Mehndiratta, Toni Meier, Ritesh G. Menezes, Atte Meretoja, Tomislav Mestrovic, Bartosz Miazgowski, Tomasz Miazgowski, Irmina Maria Michalek, Ted R. Miller, Erkin M. Mirrakhimov, Hamed Mirzaei, Babak Moazen, Masoud Moghadaszadeh, Yousef Mohammad, Dara K. Mohammad, Shafiu Mohammed, Mohammed A. Mohammed, Yaser Mokhayeri, Mariam Molokhia, Ahmed A. Montasir, Ghobad Moradi, Rahmatollah Moradzadeh, Paula Moraga, Lidia Morawska, Ilais Moreno Velásquez, Jakub Morze, Sumaira Mubarik, Walter Muruet, Kamarul Imran Musa, Ahamarshan J. Nagarajan, Mahdi Nalini, Vinay Nangia, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Bruno R. Nascimento, Vinod C. Nayak, Javad Nazari, Milad Nazarzadeh, Ruxandra I. Negoi, Sandhya Neupane Kandel, Huong L.T. Nguyen, Molly R. Nixon, Bo Norrving, Jean Jacques Noubiap, Brice E. Nouthe, Christoph Nowak, Oluwakemi O. Odukoya, Felix A. Ogbo, Andrew T. Olagunju, Hans Orru, Alberto Ortiz, Samuel M. Ostroff, Jagadish Rao Padubidri, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Utsav Parekh, Eun-Cheol Park, Mojtaba Parvizi, Fatemeh Pashazadeh Kan, Urvish K. Patel, Mona Pathak, Rajan Paudel, Veincent Christian F. Pepito, Arokiasamy Perianayagam, Norberto Perico, Hai Q. Pham, Thomas Pilgrim, Michael A. Piradov, Farhad Pishgar, Vivek Podder, Roman V. Polibin, Akram Pourshams, Dimas R.A. Pribadi, Navid Rabiee, Mohammad Rabiee, Amir Radfar, Alireza Rafiei, Fakher Rahim, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Amir Masoud Rahmani, Ivo Rakovac, Pradhum Ram, Sudha Ramalingam, Juwel Rana, Priyanga Ranasinghe, Sowmya J. Rao, Priya Rathi, Lal Rawal, Wasiq F. Rawasia, Reza Rawassizadeh, Giuseppe Remuzzi, Andre M.N. Renzaho, Aziz Rezapour, Seyed Mohammad Riahi, Ross L. Roberts-Thomson, Leonardo Roever, Peter Rohloff, Michele Romoli, Gholamreza Roshandel, Godfrey M. Rwegerera, Seyedmohammad Saadatagah, Maha M. Saber-Ayad, Siamak Sabour, Simona Sacco, Masoumeh Sadeghi, Sahar Saeedi Moghaddam, Saeed Safari, Amirhossein Sahebkar, Sana Salehi, Hamideh Salimzadeh, Mehrnoosh Samaei, Abdallah M. Samy, Itamar S. Santos, Milena M. Santric-Milicevic, Nizal Sarrafzadegan, Arash Sarveazad, Thirunavukkarasu Sathish, Monika Sawhney, Mete Saylan, Maria I. Schmidt, Aletta E. Schutte, Subramanian Senthilkumaran, Sadaf G. Sepanlou, Feng Sha, Saeed Shahabi, Izza Shahid, Masood A. Shaikh, Mahdi Shamali, Morteza Shamsizadeh, Md Shajedur Rahman Shawon, Aziz Sheikh, Mika Shigematsu, Min-Jeong Shin, Jae Il Shin, Rahman Shiri, Ivy Shiue, Kerem Shuval, Soraya Siabani, Tariq J. Siddiqi, Diego A.S. Silva, Jasvinder A. Singh, Ambrish Singh Mtech, Valentin Y. Skryabin, Anna A. Skryabina, Amin Soheili, Emma E. Spurlock, Leo Stockfelt, Stefan Stortecky, Saverio Stranges, Rizwan Suliankatchi Abdulkader, Hooman Tadbiri, Eyayou G. Tadesse, Degena B. Tadesse, Masih Tajdini, Md Tariqujjaman, Berhane F. Teklehaimanot, Mohamad-Hani Temsah, Ayenew K. Tesema, Bhaskar Thakur, Kavumpurathu R. Thankappan, Rekha Thapar, Amanda G. Thrift, Binod Timalsina, Marcello Tonelli, Mathilde Touvier, Marcos R. Tovani-Palone, Avnish Tripathi, Jaya P. Tripathy, Thomas C. Truelsen, Guesh M. Tsegay, Gebiyaw W. Tsegaye, Nikolaos Tsilimparis, Biruk S. Tusa, Stefanos Tyrovolas, Krishna Kishore Umapathi, Brigid Unim, Bhaskaran Unnikrishnan, Muhammad S. Usman, Muthiah Vaduganathan, Pascual R. Valdez, Tommi J. Vasankari, Diana Z. Velazquez, Narayanaswamy Venketasubramanian, Giang T. Vu, Isidora S. Vujcic, Yasir Waheed, Yanzhong Wang, Fang Wang, Jingkai Wei, Robert G. Weintraub, Abrha H. Weldemariam, Ronny Westerman, Andrea S. Winkler, Charles S. Wiysonge, Charles D.A. Wolfe, Befikadu Legesse Wubishet, Gelin Xu, Ali Yadollahpour, Kazumasa Yamagishi, Lijing L. Yan, Srikanth Yandrapalli, Yuichiro Yano, Hiroshi Yatsuya, Tomas Y. Yeheyis, Yigizie Yeshaw, Christopher S. Yilgwan, Naohiro Yonemoto, Chuanhua Yu, Hasan Yusefzadeh, Geevar Zachariah, Sojib Bin Zaman, Muhammed S. Zaman, Maryam Zamanian, Ramin Zand, Alireza Zandifar, Afshin Zarghi, Mikhail S. Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Yunquan Zhang, Wangjian Zhang, Chenwen Zhong, Zhiyong Zou, Yves Miel H. Zuniga, and Christopher J.L. Murray

Subjects
BMI, body mass index, GBD, Global Burden of Diseases, Injuries, and Risk Factors Study, IS, ischemic stroke, 030204 cardiovascular system & hematology, MV, mitral valve, SDI, sociodemographic index, Global Health, UI, uncertainty interval, Global Burden of Disease, GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group, 0302 clinical medicine, Cost of Illness, LDL, low-density lipoprotein, Case fatality rate, Global health, 030212 general & internal medicine, IKF, impaired kidney function, 1102 Cardiorespiratory Medicine and Haematology, Incidence (epidemiology), Health Policy, IHD, ischemic heart disease, 1. No poverty, AC, alcoholic cardiomyopathy, 3. Good health, HICs, high-income countries, Cardiovascular Diseases, DALYs, disability-adjusted life years, TMREL, theoretical minimum risk exposure level, Public Health, HHD, hypertensive heart disease, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, AF, atrial fibrillation, Population health, CVD, cardiovascular disease, LMICs, low- and middle-income countries, PM, particulate matter, 1117 Public Health and Health Services, 03 medical and health sciences, JACC State-of-the-Art Review, RHD, rheumatic heart disease, Environmental health, medicine, Humans, LPA, low physical activity, YLLs, years of life lost, Health policy, Disease burden, PAD, peripheral artery disease, business.industry, SBP, systolic blood pressure, Public health, CKD, chronic kidney disease, The Present and Future, AFL, atrial flutter, Correction, HAP, household air pollution, ICD, International Classification of Diseases, CAVD, calcific aortic valve disease, YLDs, years lived with disability, Years of potential life lost, CHA, congenital heart anomalies, Cardiovascular System & Hematology, Heart Disease Risk Factors, business, population health
Abstract

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases., Central Illustration, Highlights • The burden of CVD, in number of DALYs and deaths, continues to increase globally. • CVD burden attributable to modifiable risk factors continues to increase globally. • Countries should invest in existing cost-effective public health programs and clinical interventions to target modifiable risks, promote healthy aging across the lifespan, and reduce disability and premature death due to CVD.

Published
2020

33. Unintended consequences of programmatic changes to infant and young child feeding practices in Bangladesh

Author

Gobinda Karmakar, Tahmeed Ahmed, Mahfuzur Rahman, Sharmin Khan Luies, Haribondhu Sarma, and Md. Tariqujjaman

Subjects
0301 basic medicine, media_common.quotation_subject, lcsh:Gynecology and obstetrics, 03 medical and health sciences, community health workers, micronutrient powder, 0302 clinical medicine, Promotion (rank), infant and young child feeding, Environmental health, Humans, Medicine, Pooled data, Micronutrients, 030212 general & internal medicine, Child, Infant Nutritional Physiological Phenomena, lcsh:RC620-627, Generalized estimating equation, lcsh:RG1-991, media_common, Bangladesh, 030109 nutrition & dietetics, Nutrition and Dietetics, Young child, Unintended consequences, business.industry, unintended consequences, lcsh:RJ1-570, Public Health, Environmental and Occupational Health, Infant, Obstetrics and Gynecology, lcsh:Pediatrics, Original Articles, Feeding Behavior, lcsh:Nutritional diseases. Deficiency diseases, Breast Feeding, Cross-Sectional Studies, Incentive, Relative risk, Pediatrics, Perinatology and Child Health, Community health, Original Article, Female, business
Abstract

BRAC, an international development organization, implemented a home‐fortification programme from 2014 to 2018 in Bangladesh. This study aimed to understand the unintended consequences of programmatic changes that occurred during the implementation of the programme on the prevalence of good infant and young child feeding (IYCF) practices and other associated factors. We used pooled data from eight cross‐sectional surveys and data from a series of qualitative investigations carried out as part of a mixed‐methods evaluation approach. A total of 6,479 caregivers of children aged 6 to 23 months participated in the surveys. The prevalence of good IYCF practices increased from baseline (42.1%) to midline (45.3%), but it decreased at the endline survey (31.9%). Qualitative investigations identified several reasons for low IYCF practices at the programme level, such as the withdrawal of community health worker (CHW) incentives for promoting IYCF, providing incentives for the home‐fortification of micronutrient powder (MNP) and changing the focus from IYCF promotion to MNP promotion. A multivariable generalized estimating equation model for pooled data revealed that caregivers were 28% (adjusted risk ratio [ARR]: 0.72, 95% CI [0.67, 0.78]) less likely to maintain good IYCF practices during the period when CHWs were not incentivized to promote IYCF compared to the period when CHWs were incentivized to promote it. The prevalence of good IYCF practices decreased from both baseline and midline to the endline survey due to the unintended consequences of the programmatic changes. An integrated intervention strategy to promote the home‐fortification of MNP and IYCF could be helpful to avoid unintended negative consequences of programmatic changes.

Published
2020

34. Anaemia in women of reproductive age in low- and middle-income countries: progress towards the 2025 global nutrition target

Author

Md Mehedi Hasan, Ricardo Soares Magalhaes, Sarah Garnett, Yaqoot Fatima, Md Tariqujjaman, Sonia Pervin, Saifuddin Ahmed, and Abdullah Mamun

Subjects
Adult, Adolescent, Public Health, Environmental and Occupational Health, Anemia, Bayes Theorem, Middle Aged, Hemoglobins, Young Adult, Cross-Sectional Studies, Pregnancy, Prevalence, Humans, Female, Developing Countries
Abstract

To examine trends in, and projections of, the prevalence of anaemia in women of reproductive age in low- and middle-income countries at national and subpopulation levels.We used nationally representative data from repeated cross-sectional Demographic and Health Surveys (DHS) on 1 092 512 women of reproductive age (15-49 years) from 15 low- and middle-income countries. We defined anaemia as haemoglobin 11 g/dL for pregnant women and 12 g/dL for non-pregnant women. We analysed data using Bayesian linear regression analyses.During 2000-2018, the prevalence of anaemia in women of reproductive age decreased in nine countries, with the highest decrease in Malawi (-2.5%), and increased in six countries, with the highest increase in Burundi (10.9%). All countries are projected to have a prevalence of anaemia ≥ 15% in 2025, with the highest level in Burundi (66.8%). The prevalence of anaemia and projection of prevalence varied between and within countries. Women's education, family wealth and place of residence had the highest impact on the current and projected prevalence rates of anaemia. Seven countries had a prevalence of anaemia ≥ 40%, which we defined as a severe public health problem, in the earliest and latest DHS and this prevalence is projected to persist in 2025.None of the 15 countries is likely to meet the global nutrition target of a 50% reduction in the prevalence of anaemia in women of reproductive age by 2025. Global and country leaders should reconsider nutrition policies and reallocate resources targeting countries and communities at risk.Examiner les tendances et projections en ce qui concerne la prévalence de l'anémie chez les femmes en âge de procréer dans les pays à faible et moyen revenu, tant au niveau national qu'au sein des sous-populations.Nous avons utilisé des données représentatives à l'échelle nationale, extraites des enquêtes démographiques et sanitaires (EDS) transversales à passages répétés menées sur 1 092 512 femmes en âge de procréer (15–49 ans) originaires de 15 pays à faible et moyen revenu. Nous avons défini l'anémie comme correspondant à un taux d'hémoglobine11 g/dL pour les femmes enceintes, et12 g/dL pour celles qui ne le sont pas. Enfin, nous avons analysé ces données à l'aide d'un modèle de régression linéaire bayésienne.Entre 2000 et 2018, la prévalence de l'anémie chez les femmes en âge de procréer a diminué dans neuf pays, surtout au Malawi (-2,5%). En revanche, elle a augmenté dans six pays, en particulier au Burundi (10,9%). Tous les pays devraient enregistrer une prévalence ≥ 15% en 2025, avec le taux le plus élevé au Burundi (66,8%). Des variations en termes de prévalence de l'anémie et de projections ont été observées entre les différents pays, mais aussi au sein d'un même pays. L'éducation des femmes, la situation financière de leur famille et leur lieu de résidence sont les éléments qui ont eu le plus d'impact sur les taux de prévalence actuels et prévisionnels. Sept pays ont enregistré une prévalence ≥ 40%, ce que nous considérons comme un grave problème de santé publique dans les premières et dernières EDS; cette prévalence devrait persister en 2025.Aucun des 15 pays étudiés ne devrait atteindre la cible mondiale de nutrition, qui consiste à réduire d'ici 2025 la prévalence de l'anémie de 50% chez les femmes en âge de procréer. Les dirigeants nationaux et mondiaux devraient repenser leurs politiques de nutrition et réaffecter les ressources, afin de privilégier les pays et les communautés à risque.Analizar las tendencias y las proyecciones de la prevalencia de la anemia en las mujeres en edad reproductiva de países de ingresos bajos y medios a nivel nacional y de subpoblación.Se utilizaron los datos representativos a nivel nacional de repetidas Encuestas Demográficas y de Salud (EDS) transversales sobre 1 092 512 mujeres en edad reproductiva (15-49 años) de 15 países de ingresos bajos y medios. Se definió la anemia como una hemoglobina11 g/dl para las embarazadas y12 g/dl para las no embarazadas. Los datos se analizaron mediante un análisis de regresión lineal bayesiano.Durante el periodo 2000-2018, la prevalencia de la anemia en las mujeres en edad reproductiva disminuyó en nueve países, con el mayor descenso en Malawi (-2,5 %), y aumentó en seis países, con el mayor incremento en Burundi (10,9 %). Se prevé que todos los países tengan una prevalencia de anemia ≥15 % en 2025, con el nivel más alto en Burundi (66,8 %). La prevalencia de la anemia y la proyección de la prevalencia variaron entre los países y dentro de ellos. La educación de las mujeres, la riqueza de la familia y el lugar de residencia fueron los factores que más influyeron en las tasas de prevalencia actual y proyectada de la anemia. Siete países tenían una prevalencia de anemia ≥40 %, que se definió como un problema grave de salud pública, en las primeras y últimas EDS, y se prevé que esta prevalencia persista en 2025.Es probable que ninguno de los 15 países cumpla la meta global de nutrición de reducir en un 50 % la prevalencia de la anemia en mujeres en edad reproductiva para 2025. Los líderes mundiales y nacionales deben replantear las políticas de nutrición y reasignar los recursos que se destinan a los países y comunidades en riesgo.فحص اتجاهات وتوقعات انتشار فقر الدم لدى النساء في سن الإنجاب في الدول ذات الدخل المنخفض والدخل المتوسط على المستوى الوطني والمستوى السكاني الثانوي.قمنا باستخدام بيانات تمثيلية على الصعيد الوطني من المسوح السكانية والصحية المقطعية المستعرضة المتكررة على 1092512 امرأة في سن الإنجاب (من 15 إلى 49 سنة) من 15 دولة من الدول ذات الدخل المنخفض والدخل المتوسط. حددنا فقر الدم على أنه نسبة الهيموغلوبين الأقل من 11 جم/ديسيلتر للنساء الحوامل، وأقل من 12 جم/ديسيلتر للنساء غير الحوامل. كما قمنا بتحليل البيانات باستخدام تحليلات التحوف الخطي Bayesian.خلال الفترة من 2000 إلى 2018، انخفض انتشار فقر الدم لدى النساء في سن الإنجاب في تسع دول، وكان أعلى انخفاض في ملاوي (-2.5%)، وزاد في ست دول، وكانت أعلى زيادة في بوروندي (10.9%). من المتوقع أن يكون معدل انتشار فقر الدم في جميع الدول ≥ 15% في عام 2025، مع أعلى مستوى في بوروندي (66.8%). تفاوت انتشار فقر الدم وتوقع انتشاره بين الدول وداخلها. كان لتعليم المرأة، وثروة الأسرة، ومكان الإقامة، أكبر تأثير على معدلات الانتشار الحالية والمتوقعة لفقر الدم. كان معدل انتشار فقر الدم في سبع دول ≥ 40%، وهو ما عرّفناه بأنه مشكلة صحية عامة خطيرة، في أقدم وأحدث المسوح السكانية الصحية (DHS)، ومن المتوقع أن يستمر هذا الانتشار في عام 2025.ليس من المحتمل أن تلبي أية دولة من الدول الخمسة عشر هدف التغذية العالمي المتمثل في خفض معدل انتشار فقر الدم لدى النساء في سن الإنجاب بنسبة 50% بحلول عام 2025. يجب على القادة العالميين وقادة الدول إعادة النظر في سياسات التغذية، وإعادة تخصيص الموارد التي تستهدف الدول والمجتمعات التي تواجه الخطر.在全国和分组人口层面调查低收入和中等收入国家育龄妇女贫血患病率的趋势和预测。.我们使用来自 15 个低收入和中等收入国家的 1,092,512 名育龄妇女（15-49 岁）的反复横断面人口健康调查 (DHS) 中具有全国代表性的数据。我们将贫血定义为孕妇血红蛋白11 g/dL，非孕妇的血红蛋白12 g/dL。我们使用贝叶斯定理线性回归分析法对数据进行分析。.2000-2018 年期间，育龄妇女贫血患病率在九个国家下降，其中马拉维下降幅度最大 (-2.5%)，在六个国家上升，其中布隆迪上升幅度最大 (10.9%)。预计到 2025 年，所有国家的贫血患病率将达到³15%，其中布隆迪的患病率最高 (66.8%)。贫血患病率和患病率预测在各个国家之间和各个国家内部各不相同。妇女的教育、家庭财富和居住地对当前预计的贫血患病率影响最大。在最早和最新的 DHS 中，七个国家的贫血患病率为 ³40%，我们将其定义为严重的公共卫生问题，预计这种患病率将持续到 2025 年。.15 个国家均不可能在 2025 年实现育龄妇女贫血患病率降低 50% 的全球营养目标。全球和国家领导人应重新考虑营养政策，并对处于风险的地区和国家重新分配资源。.Изучить тенденции и прогнозы распространенности анемии среди женщин репродуктивного возраста в странах с низким и средним уровнем дохода на национальном и субпопуляционном уровнях.Авторы использовали национальные репрезентативные данные из повторных перекрестных демографических и медико-санитарных обследований (DHS) 1 092 512 женщин репродуктивного возраста (15–49 лет) из 15 стран с низким и средним уровнем дохода. Авторы определили анемию как уровень гемоглобина 11,0 г/дл для беременных женщин и 12,0 г/дл для небеременных женщин. Авторы проанализировали данные с помощью анализа байесовской линейной регрессии.В течение 2000–2018 гг. распространенность анемии среди женщин репродуктивного возраста снизилась в девяти странах, при этом наибольшее снижение произошло в Малави (–2,5%), и увеличилась в шести странах, при этом максимальное увеличение произошло в Бурунди (10,9%). Прогнозируется, что во всех странах распространенность анемии составит ≥ 15% в 2025 г. с самым высоким уровнем в Бурунди (66,8%). Распространенность анемии и прогноз распространенности различались как внутри стран, так и между странами. Наибольшее влияние на текущие и прогнозируемые показатели распространенности анемии оказали уровень образования женщин, благосостояние семьи и место жительства. В семи странах распространенность анемии составляла ≥ 40%, которую авторы в самом раннем и последнем DHS определили как серьезную проблему общественного здравоохранения. По прогнозам, эта распространенность сохранится в 2025 году.Ни одна из 15 стран, вероятно, не достигнет глобальной цели в области питания, а именно снижения на 50% распространенности анемии среди женщин репродуктивного возраста к 2025 году. Мировые лидеры и руководства стран должны пересмотреть политику в области питания и перераспределить ресурсы, ориентируясь на страны и группы женщин, которые находятся в зоне риска.

Published
2020

35. Examining the prevalence, correlates and inequalities of undiagnosed hypertension in Nepal: a population-based cross-sectional study

Author

Anne Cleary, Md. Tariqujjaman, Mehedi Hasan, Fariha Tasnim, Sayem Ahmed, and Abdullah Al Mamun

Subjects
Adult, Male, medicine.medical_specialty, hypertension, Cross-sectional study, Epidemiology, Blood Pressure, wa_395, Overweight, Lower risk, Nepal, Risk Factors, Environmental health, medicine, Prevalence, Humans, Social determinants of health, Socioeconomic status, business.industry, Public health, public health, wa_900, General Medicine, Blood pressure, Cross-Sectional Studies, wg_100, Female, medicine.symptom, business
Abstract

ObjectiveTo examine the prevalence, correlates and sociodemographic inequalities of undiagnosed hypertension in Nepal.DesignThis study used cross-sectional 2016 Nepal Demographic and Health Survey (NDHS) data. Undiagnosed patients with hypertension were defined as an NDHS respondent who was diagnosed as hypertensive (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) during the survey, but never took any prescribed anti-hypertensive medicine to lower/control blood pressure and was never identified as having hypertension by a health professional prior the survey. Multiple binary logistic regression analysis was performed, and Concentration Index was measured.SettingNepal.ParticipantsAdult patients with hypertension.ResultsAmong 3334 patients with hypertension, 50.4% remained undiagnosed during the survey in Nepal. Adjusted model reveals that patients who were male, belonged to households other than the highest wealth quintile, and lived in province 4 and province 5 were at higher risk of remaining undiagnosed for hypertension. Patients who were ≥65 years of age and were overweight/obese were at lower risk of remaining undiagnosed for hypertension. The poor-rich gap was 24.6 percentage points (Q1=64.1% vs Q5=39.6%) and poor:rich ratio was 1.6 (Q1/Q5=1.6) in the prevalence of undiagnosed hypertension. Undiagnosed hypertension was disproportionately higher among lower socioeconomic status groups (Concentration Index, C=−0.18). Inequalities in the prevalence of undiagnosed hypertension further varied across other geographic locations, including place of residence, ecological zones and administrative provinces.ConclusionsUndiagnosed hypertension was highly prevalent in Nepal and there were substantial inequalities by sociodemographics and subnational levels. Increasing awareness, strengthening routine screening to diagnose hypertension at primary health service facilities and enactment of social health insurance policy may help Nepal to prevent and control this burden.

Published
2020

36. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study

Author

Roth, Gregory A, Mensah, George A, Johnson, Catherine O, Addolorato, Giovanni, Ammirati, Enrico, Baddour, Larry M, Barengo, Noël C, Beaton, Andrea Z, Benjamin, Emelia J, Benziger, Catherine P, Bonny, Aimé, Brauer, Michael, Brodmann, Marianne, Cahill, Thomas J, Carapetis, Jonathan, Catapano, Alberico L, Chugh, Sumeet S, Cooper, Leslie T, Coresh, Josef, Criqui, Michael, DeCleene, Nicole, Eagle, Kim A, Emmons-Bell, Sophia, Feigin, Valery L, Fernández-Solà, Joaquim, Fowkes, Gerry, Gakidou, Emmanuela, Grundy, Scott M, He, Feng J, Howard, George, Hu, Frank, Inker, Lesley, Karthikeyan, Ganesan, Kassebaum, Nicholas, Koroshetz, Walter, Lavie, Carl, Lloyd-Jones, Donald, Lu, Hong S, Mirijello, Antonio, Temesgen, Awoke Misganaw, Mokdad, Ali, Moran, Andrew E, Muntner, Paul, Narula, Jagat, Neal, Bruce, Ntsekhe, Mpiko, Moraes de Oliveira, Glaucia, Otto, Catherine, Owolabi, Mayowa, Pratt, Michael, Rajagopalan, Sanjay, Reitsma, Marissa, Ribeiro, Antonio Luiz P, Rigotti, Nancy, Rodgers, Anthony, Sable, Craig, Shakil, Saate, Sliwa-Hahnle, Karen, Stark, Benjamin, Sundström, Johan, Timpel, Patrick, Tleyjeh, Imad M, Valgimigli, Marco, Vos, Theo, Whelton, Paul K, Yacoub, Magdi, Zuhlke, Liesl, Murray, Christopher, Fuster, Valentin, GBD-NHLBI-JACC Global, Burden of, Cardiovascular Diseases, Writing Group, Gregory A, Roth George, A Mensah, Catherine O, Johnson, Giovanni, Addolorato, Enrico, Ammirati, Larry M, Baddour Noel, C Barengo, Andrea, Beaton, Emelia J, Benjamin Catherine, P Benziger, Aime, Bonny, Michael, Brauer, Marianne, Brodmann, Thomas J, Cahill Jonathan, R Carapetis, Alberico L, Catapano, Sumeet, Chugh, Leslie T, Cooper, Josef, Coresh, Michael H, Criqui Nicole, K DeCleene, Kim A, Eagle, Sophia, Emmons-Bell, Valery L, Feigin, Joaquim, Fernández-Sola, F Gerry, R Fowkes, Emmanuela, Gakidou, Scott M, Grundy Feng, J He, George, Howard, Frank, Hu, Lesley, Inker, Ganesan, Karthikeyan, Nicholas J, Kassebaum Walter, J Koroshetz, Carl, Lavie, Donald, Lloyd-Jones, Hong S, Antonio, Mirijello, Awoke T, Misganaw Ali, H Mokdad, Andrew E, Moran, Paul, Muntner, Jagat, Narula, Bruce, Neal, Mpiko, Ntsekhe, Gláucia M, M Oliveira, Catherine M, Otto Mayowa, O Owolabi, Michael, Pratt, Sanjay, Rajagopalan, Marissa B, Reitsma Antonio, Luiz P, Ribeiro Nancy, A Rigotti, Anthony, Rodgers, Craig A, Sable Saate, S Shakil, Karen, Sliwa, Benjamin A, Stark, Johan, Sundström, Patrick, Timpel, Imad I, Tleyjeh, Marco, Valgimigli, Theo, Vos, Paul K, Whelton, Magdi, Yacoub, Liesl J, Zuhlke, Mohsen, Abbasi-Kangevari, Alireza, Abdi, Aidin, Abedi, Victor, Aboyans, Woldu A, Abrha, Eman, Abu-Gharbieh, Abdelrahman I, Abushouk, Dilaram, Acharya, Tim, Adair, Oladimeji M, Adebayo, Zanfina, Ademi, Shailesh M, Advani, Khashayar, Afshari, Ashkan, Afshin, Gina, Agarwal, Pradyumna, Agasthi, Sohail, Ahmad, Sepideh, Ahmadi, Muktar B, Ahmed, Budi, Aji, Yonas, Akalu, Wuraola, Akande-Sholabi, Addis, Aklilu, Chisom J, Akunna, Fares, Alahdab, Ayman, Al-Eyadhy, Khalid F, Alhabib Sheikh, M Alif, Vahid, Alipour, Syed M, Aljunid, François, Alla, Amir, Almasi-Hashiani, Sami, Almustanyir, Rajaa M, Al-Raddadi Adeladza, K Amegah, Saeed, Amini, Arya, Aminorroaya, Hubert, Amu, Dickson A, Amugsi, Robert, Ancuceanu, Deanna, Anderlini, Tudorel, Andrei, Catalina Liliana, Andrei, Alireza, Ansari-Moghaddam, Zelalem A, Anteneh Ippazio, Cosimo Antonazzo, Benny, Antony, Razique, Anwer, Lambert T, Appiah, Jalal, Arabloo, Johan, Ärnlöv, Kurnia D, Artanti, Zerihun, Ataro, Marcel, Ausloos, Leticia, Avila-Burgos, Asma T, Awan Mamaru, A Awoke, Henok T, Ayele Muluken, A Ayza, Samad, Azari, Darshan B, B, Nafiseh, Baheiraei, Atif A, Baig, Ahad, Bakhtiari, Maciej, Banach, Palash C, Banik Emerson, A Baptista, Miguel A, Barboza, Lingkan, Barua, Sanjay, Basu, Neeraj, Bedi, Yannick, Béjot, Derrick A, Bennett Isabela, M Bensenor, Adam E, Berman Yihienew, M Bezabih, Akshaya S, Bhagavathula, Sonu, Bhaskar, Krittika, Bhattacharyya, Ali, Bijani, Boris, Bikbov, Mulugeta M, Birhanu, Archith, Boloor, Luisa C, Brant, Hermann, Brenner, Nikolay I, Briko Zahid, A Butt, Florentino Luciano, Caetano Dos, Santos Leah, E Cahill, Lucero, Cahuana-Hurtado, Luis A, Cámera Ismael, R Campos-Nonato, Carlos, Cantu-Brito, Josip, Car, Juan J, Carrero, Felix, Carvalho, Carlos A, Castañeda-Orjuela, Ferrán, Catalá-López, Ester, Cerin, Jaykaran, Charan, Vijay Kumar, Chattu, Simiao, Chen, Ken L, Chin Jee-Young, J Choi, Dinh-Toi, Chu, Sheng-Chia, Chung, Cirillo, Massimo, Sean, Coffey, Sara, Conti, Vera M, Costa David, K Cundiff, Omid, Dadras, Baye, Dagnew, Xiaochen, Dai, Albertino A, M Damasceno, Lalit, Dandona, Rakhi, Dandona, Kairat, Davletov, Vanessa De, la Cruz-Góngora, Fernando P, De la, Hoz Jan-Walter, De Neve, Edgar, Denova-Gutiérrez, Meseret Derbew, Molla Behailu, T Derseh, Rupak, Desai, Günther, Deuschl, Samath D, Dharmaratne, Meghnath, Dhimal, Raja Ram, Dhungana, Mostafa, Dianatinasab, Daniel, Diaz, Shirin, Djalalinia, Klara, Dokova, Abdel, Douiri, Bruce B, Duncan Andre, R Duraes, Arielle W, Eagan, Sanam, Ebtehaj, Aziz, Eftekhari, Sahar, Eftekharzadeh, Michael, Ekholuenetale, Nevine El, Nahas Islam, Y Elgendy, Muhammed, Elhadi, Shaimaa I, El-Jaafary, Sadaf, Esteghamati, Atkilt E, Etisso, Oghenowede, Eyawo, Ibtihal, Fadhil, Emerito Jose, A Faraon, Pawan S, Faris, Medhat, Farwati, Farshad, Farzadfar, Eduarda, Fernandes, Carlota Fernandez, Prendes, Pietro, Ferrara, Irina, Filip, Florian, Fischer, David, Flood, Takeshi, Fukumoto, Mohamed M, Gad, Shilpa, Gaidhane, Morsaleh, Ganji, Jalaj, Garg, Abadi K, Gebre Birhan, G Gebregiorgis, Kidane Z, Gebregzabiher Gebreamlak, G Gebremeskel, Lemma, Getacher, Abera Getachew, Obsa, Alireza, Ghajar, Ahmad, Ghashghaee, Nermin, Ghith, Simona, Giampaoli, Syed Amir, Gilani Paramjit, S Gill, Richard F, Gillum Ekaterina, V Glushkova, Elena V, Gnedovskaya, Mahaveer, Golechha, Kebebe B, Gonfa Amir, Hossein Goudarzian, Alessandra C, Goulart Jenny, S Guadamuz, Avirup, Guha, Yuming, Guo, Rajeev, Gupta, Vladimir, Hachinski, Nima, Hafezi-Nejad, Teklehaimanot G, Haile Randah, R Hamadeh, Samer, Hamidi, Graeme J, Hankey, Arief, Hargono, Risky K, Hartono, Maryam, Hashemian, Abdiwahab, Hashi, Shoaib, Hassan, Hamid Y, Hassen Rasmus, J Havmoeller, Simon I, Hay, Khezar, Hayat, Golnaz, Heidari, Claudiu, Herteliu, Ramesh, Holla, Mostafa, Hosseini, Mehdi, Hosseinzadeh, Mihaela, Hostiuc, Sorin, Hostiuc, Mowafa, Househ, Junjie, Huang, Ayesha, Humayun, Ivo, Iavicoli, Charles U, Ibeneme Segun, E Ibitoye, Olayinka S, Ilesanmi Irena, M Ilic, Milena D, Ilic, Usman, Iqbal, Seyed Sina, N Irvani, Sheikh Mohammed, Shariful Islam, Rakibul M, Islam, Hiroyasu, Iso, Masao, Iwagami, Vardhmaan, Jain, Tahereh, Javaheri, Sathish Kumar, Jayapal, Shubha, Jayaram, Ranil, Jayawardena, Panniyammakal, Jeemon, Ravi P, Jha Jost, B Jonas, Jitendra, Jonnagaddala, Farahnaz, Joukar, Jacek J, Jozwiak, Mikk, Jürisson, Ali, Kabir, Tanvir, Kahlon, Rizwan, Kalani, Rohollah, Kalhor, Ashwin, Kamath, Ibrahim, Kamel, Himal, Kandel, Amit, Kandel, André, Karch, Ayele Semachew, Kasa Patrick, D M, C Katoto, Gbenga A, Kayode Yousef, S Khader, Mohammad, Khammarnia, Muhammad S, Khan Md, Nuruzzaman Khan, Maseer, Khan, Ejaz A, Khan, Khaled, Khatab, Gulam M, A Kibria, Yun Jin, Kim Gyu, Ri Kim, Ruth W, Kimokoti, Sezer, Kisa, Adnan, Kisa, Mika, Kivimäki, Dhaval, Kolte, Ali, Koolivand, Vladimir A, Korshunov Sindhura, Lakshmi Koulmane, Laxminarayana, Ai, Koyanagi, Kewal, Krishan, Vijay, Krishnamoorthy, Barthelemy Kuate, Defo Burcu, Kucuk Bicer, Vaman, Kulkarni, G Anil, Kumar, Nithin, Kumar, Om P, Kurmi, Dian, Kusuma, Gene F, Kwan Carlo, La Vecchia, Ben, Lacey, Tea, Lallukka, Qing, Lan, Savita, Lasrado, Zohra S, Lassi, Paolo, Lauriola, Wayne R, Lawrence, Avula, Laxmaiah, Kate E, LeGrand, Ming-Chieh, Li, Bingyu, Li, Shanshan, Li, Stephen S, Lim, Lee-Ling, Lim, Hualiang, Lin, Ziqiang, Lin, Ro-Ting, Lin, Xuefeng, Liu, Alan D, Lopez, Stefan, Lorkowski, Paulo A, Lotufo, Alessandra, Lugo, Nirmal K, M, Fabiana, Madotto, Morteza, Mahmoudi, Azeem, Majeed, Reza, Malekzadeh, Ahmad A, Malik Abdullah, A Mamun, 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Santos, Leah, Cahill, E, Lucero, Cahuana-Hurtado, Luis, A, Cámera, Ismael, Campos-Nonato, R, Carlos, Cantu-Brito, Josip, Car, Juan, J, Carrero, Felix, Carvalho, Carlos, A, Castañeda-Orjuela, Ferrán, Catalá-López, Ester, Cerin, Jaykaran, Charan, Vijay, Kumar, Chattu, Simiao, Chen, Ken, L, Chin, Jee-Young, Dinh-Toi, Chu, Sheng-Chia, Chung, Cirillo, Massimo, Sean, Coffey, Sara, Conti, Vera, M, Costa, David, Cundiff, K, Omid, Dadra, Baye, Dagnew, Xiaochen, Dai, Albertino, A, Damasceno, M, Lalit, Dandona, Rakhi, Dandona, Kairat, Davletov, Vanessa, De, Cruz-Góngora, La, Fernando, P, De, La, Hoz, Jan-Walter, Neve, De, Edgar, Denova-Gutiérrez, Meseret, Derbew, Molla, Behailu, Derseh, T, Rupak, Desai, Günther, Deuschl, Samath, D, Dharmaratne, Meghnath, Dhimal, Raja, Ram, Dhungana, Mostafa, Dianatinasab, Daniel, Diaz, Shirin, Djalalinia, Klara, Dokova, Abdel, Douiri, Bruce, B, Duncan, Andre, Duraes, R, Arielle, W, Eagan, Sanam, Ebtehaj, Aziz, Eftekhari, Sahar, Eftekharzadeh, Michael, Ekholuenetale, Nevine, El, Nahas, Islam, Elgendy, Y, Muhammed, Elhadi, Shaimaa, I, El-Jaafary, Sadaf, Esteghamati, Atkilt, E, Etisso, Oghenowede, Eyawo, Ibtihal, Fadhil, Emerito, Jose, Faraon, A, Pawan, S, Faris, Medhat, Farwati, Farshad, Farzadfar, Eduarda, Fernande, Carlota, Fernandez, Prendes, Pietro, Ferrara, Irina, Filip, Florian, Fischer, David, Flood, Takeshi, Fukumoto, Mohamed, M, Gad, Shilpa, Gaidhane, Morsaleh, Ganji, Jalaj, Garg, Abadi, K, Gebre, Birhan, Gebregiorgis, G, Kidane, Z, Gebregzabiher, Gebreamlak, Lemma, Getacher, Abera, Getachew, Obsa, Alireza, Ghajar, Ahmad, Ghashghaee, Nermin, Ghith, Simona, Giampaoli, Syed, Amir, Gilani, Paramjit, Gill, S, Richard, F, Gillum, Ekaterina, Glushkova, V, Elena, V, Gnedovskaya, Mahaveer, Golechha, Kebebe, B, Gonfa, Amir, Hossein, Goudarzian, Alessandra, C, Goulart, Jenny, Guadamuz, S, Avirup, Guha, Yuming, Guo, Rajeev, Gupta, Vladimir, Hachinski, Nima, Hafezi-Nejad, Teklehaimanot, G, Haile, Randah, Samer, Hamidi, Graeme, J, Hankey, Arief, Hargono, Risky, K, Hartono, Maryam, Hashemian, Abdiwahab, Hashi, Shoaib, Hassan, Hamid, Y, Hassen, Rasmu, Havmoeller, J, Simon, I, Hay, Khezar, Hayat, Golnaz, Heidari, Claudiu, Herteliu, Ramesh, Holla, Mostafa, Hosseini, Mehdi, Hosseinzadeh, Mihaela, Hostiuc, Sorin, Hostiuc, Mowafa, Househ, Junjie, Huang, Ayesha, Humayun, Iavicoli, Ivo, Charles, U, Ibeneme, Segun, Ibitoye, E, Olayinka, S, Ilesanmi, Irena, Milena, D, Ilic, Usman, Iqbal, Seyed, Sina, Irvani, N, Sheikh, Mohammed, Shariful, Islam, Rakibul, M, Islam, Hiroyasu, Iso, Masao, Iwagami, Vardhmaan, Jain, Tahereh, Javaheri, Sathish, Kumar, Jayapal, Shubha, Jayaram, Ranil, Jayawardena, Panniyammakal, Jeemon, Ravi, P, Jha, Jost, Jonas, B, Jitendra, Jonnagaddala, Farahnaz, Joukar, Jacek, J, Jozwiak, Mikk, Jürisson, Ali, Kabir, Tanvir, Kahlon, Rizwan, Kalani, Rohollah, Kalhor, Ashwin, Kamath, Ibrahim, Kamel, Himal, Kandel, Amit, Kandel, André, Karch, Ayele, Semachew, Kasa, Patrick, D, M, Katoto, C, Gbenga, A, Kayode, Yousef, Khader, S, Mohammad, Khammarnia, Muhammad, S, Khan, Md, Nuruzzaman, Khan, Maseer, Khan, Ejaz, A, Khan, Khaled, Khatab, Gulam, M, Kibria, A, Yun, Jin, Kim, Gyu, Kim, Ri, Ruth, W, Kimokoti, Sezer, Kisa, Adnan, Kisa, Mika, Kivimäki, Dhaval, Kolte, Ali, Koolivand, Vladimir, A, Korshunov, Sindhura, Lakshmi, Koulmane, Laxminarayana, Koyanagi, Ai, Kewal, Krishan, Vijay, Krishnamoorthy, Barthelemy, Kuate, Defo, Burcu, Kucuk, Bicer, Vaman, Kulkarni, Anil, G, Kumar, Nithin, Kumar, Om, P, Kurmi, Dian, Kusuma, Gene, F, Kwan, Carlo, Vecchia, La, Ben, Lacey, Tea, Lallukka, Qing, Lan, Savita, Lasrado, Zohra, S, Lassi, Paolo, Lauriola, Wayne, R, Lawrence, Avula, Laxmaiah, Kate, E, Legrand, Ming-Chieh, Li, Bingyu, Li, Shanshan, Li, Stephen, S, Lim, Lee-Ling, Lim, Hualiang, Lin, Ziqiang, Lin, Ro-Ting, Lin, Xuefeng, Liu, Alan, D, Lopez, Stefan, Lorkowski, Paulo, A, Lotufo, Alessandra, Lugo, Nirmal, K, M, Fabiana, Madotto, Morteza, Mahmoudi, Azeem, Majeed, Reza, Malekzadeh, Ahmad, A, Malik, Abdullah, Navid, Manafi, Mohammad, Ali, Mansournia, Lorenzo, Mantovani, G, Santi, Martini, Manu, R, Mathur, Giampiero, Mazzaglia, Suresh, Mehata, Man, Mohan, Mehndiratta, Toni, Meier, Ritesh, G, Menezes, Atte, Meretoja, Tomislav, Mestrovic, Bartosz, Miazgowski, Tomasz, Miazgowski, Irmina, Maria, Michalek, Ted, Miller, R, Erkin, M, Mirrakhimov, Hamed, Mirzaei, Babak, Moazen, Masoud, Moghadaszadeh, Yousef, Mohammad, Dara, K, Mohammad, Shafiu, Mohammed, Mohammed, A, Mohammed, Yaser, Mokhayeri, Mariam, Molokhia, Ahmed, A, Montasir, Ghobad, Moradi, Rahmatollah, Moradzadeh, Paula, Moraga, Lidia, Morawska, Ilais, Moreno, Velásquez, Jakub, Morze, Sumaira, Mubarik, Walter, Muruet, Kamarul, Imran, Musa, Ahamarshan, Nagarajan, J, Mahdi, Nalini, Vinay, Nangia, Atta, Abba, Naqvi, Sreeniva, Narasimha, Swamy, Bruno, R, Nascimento, Vinod, Nayak, C, Javad, Nazari, Milad, Nazarzadeh, Ruxandra, I, Negoi, Sandhya, Neupane, Kandel, Huong, L, Nguyen, T, Molly, R, Nixon, Norrving, Bo, Jean, Jacque, Noubiap, Brice, Nouthe, E, Christoph, Nowak, Oluwakemi, O, Odukoya, Felix, Ogbo, A, Andrew, T, Olagunju, Hans, Orru, Alberto, Ortiz, Samuel, M, Ostroff, Jagadish, Rao, Padubidri, Palladino, Raffaele, Adrian, Pana, Songhomitra, Panda-Jona, Utsav, Parekh, Eun-Cheol, Park, Mojtaba, Parvizi, Fatemeh, Pashazadeh, Kan, Urvish, Patel, K, Mona, Pathak, Rajan, Paudel, Veincent, Christian, Pepito, F, Arokiasamy, Perianayagam, Norberto, Perico, Hai, Q, Pham, Thomas, Pilgrim, Michael, A, Piradov, Farhad, Pishgar, Vivek, Podder, Roman, V, Polibin, Akram, Poursham, Dimas, R, Pribadi, A, Navid, Rabiee, Mohammad, Rabiee, Amir, Radfar, Alireza, Rafiei, Fakher, Rahim, Vafa, Rahimi-Movaghar, Mohammad, Hifz, Rahman, Ur, Muhammad, Aziz, Rahman, Amir, Masoud, Rahmani, Ivo, Rakovac, Pradhum, Ram, Sudha, Ramalingam, Juwel, Rana, Priyanga, Ranasinghe, Sowmya, J, Rao, Priya, Rathi, Lal, Rawal, Wasiq, F, Rawasia, Reza, Rawassizadeh, Giuseppe, Remuzzi, Andre, M, Renzaho, N, Aziz, Rezapour, Seyed, Mohammad, Riahi, Ro, Roberts-Thomson, L, Leonardo, Roever, Peter, Rohloff, Michele, Romoli, Gholamreza, Roshandel, Godfrey, M, Rwegerera, Seyedmohammad, Saadatagah, Maha, M, Saber-Ayad, Siamak, Sabour, Simona, Sacco, Masoumeh, Sadeghi, Sahar, Saeedi, Moghaddam, Saeed, Safari, Amirhossein, Sahebkar, Sana, Salehi, Hamideh, Salimzadeh, Mehrnoosh, Samaei, Abdallah, M, Samy, Itamar, Santos, S, Milena, M, Santric-Milicevic, Nizal, Sarrafzadegan, Arash, Sarveazad, Thirunavukkarasu, Sathish, Monika, Sawhney, Mete, Saylan, Maria, I, Schmidt, Aletta, Schutte, E, Subramanian, Senthilkumaran, Sadaf, G, Sepanlou, Feng, Sha, Saeed, Shahabi, Izza, Shahid, Masood, A, Shaikh, Mahdi, Shamali, Morteza, Shamsizadeh, Shajedur, Md, Rahman, Shawon, Aziz, Sheikh, Mika, Shigematsu, Min-Jeong, Shin, Jae, Il, Shin, Rahman, Shiri, Ivy, Shiue, Kerem, Shuval, Soraya, Siabani, Tariq, J, Siddiqi, Diego, A, S, Silva, Jasvinder, Singh, A, Ambrish, Singh, Mtech, Valentin, Skryabin, Y, Anna, A, Skryabina, Amin, Soheili, Emma, E, Spurlock, Leo, Stockfelt, Stefan, Stortecky, Saverio, Strange, Rizwan, Suliankatchi, Abdulkader, Hooman, Tadbiri, Eyayou, G, Tadesse, Degena, Tadesse, B, Masih, Tajdini, Tariqujjaman, Md, Berhane, F, Teklehaimanot, Mohamad-Hani, Temsah, Ayenew, K, Tesema, Bhaskar, Thakur, Kavumpurathu, R, Thankappan, Rekha, Thapar, Amanda, G, Thrift, Binod, Timalsina, Marcello, Tonelli, Mathilde, Touvier, Marcos, R, Tovani-Palone, Avnish, Tripathi, Jaya, P, Tripathy, Thoma, Truelsen, C, Guesh, M, Tsegay, Gebiyaw, Tsegaye, W, Nikolaos, Tsilimpari, Biruk, S, Tusa, Stefanos, Tyrovola, Krishna, Kishore, Umapathi, Brigid, Unim, Bhaskaran, Unnikrishnan, Usman, Muthiah, Vaduganathan, Pascual, R, Valdez, Tommi, Vasankari, J, Diana, Z, Velazquez, Narayanaswamy, Venketasubramanian, Giang, T, Isidora, Vu, Vujcic, S, Yasir, Waheed, Yanzhong, Wang, Fang, Wang, Jingkai, Wei, Robert, G, Weintraub, Abrha, Weldemariam, H, Ronny, Westerman, Andrea, S, Winkler, Charle, Wiysonge, S, Charles, D, Wolfe, A, Befikadu, Legesse, Wubishet, Gelin, Xu, Ali, Yadollahpour, Kazumasa, Yamagishi, Lijing, L, Yan, Srikanth, Yandrapalli, Yuichiro, Yano, Hiroshi, Yatsuya, Tomas, Y, Yeheyis, Yigizie, Yeshaw, Christopher, S, Yilgwan, Naohiro, Yonemoto, Chuanhua, Yu, Hasan, Yusefzadeh, Geevar, Zachariah, Sojib, Bin, Zaman, Muhammed, Maryam, Zamanian, Ramin, Zand, Alireza, Zandifar, Afshin, Zarghi, Mikhail, S, Zastrozhin, Anasthasia, Zastrozhina, Zhi-Jiang, Zhang, Yunquan, Zhang, Wangjian, Zhang, Chenwen, Zhong, Zhiyong, Zou, Yves, Miel, Zuniga, H, Christopher, J, Murray, L, and Valentin, Fuster

Subjects
cardiovascular disease, global health, health policy, population health
Abstract

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

Published
2020

37. Additional file 1 of Can complex programs be sustained? A mixed methods sustainability evaluation of a national infant and young child feeding program in Bangladesh and Vietnam

Author

Moucheraud, Corrina, Haribondhu Sarma, Ha, Tran Thi Thu, Tahmeed Ahmed, Epstein, Adrienne, Glenn, Jeffrey, Hanh, Hoang Hong, Huong, Tran Thi Thu, Sharmin Khan Luies, Moitry, Aninda Nishat, Nhung, Doan Phuong, Payán, Denise Diaz, Mahfuzur Rahman, Md Tariqujjaman, Thuy, Tran Thi, Tuan, Tran, Bossert, Thomas J., and Kruk, Margaret E.

Abstract

Additional file 1: Appendices.

Published
2020
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38. Inequalities in the prevalence of undiagnosed hypertension among Bangladeshi adults: evidence from a nationwide survey

Author

Md. Tariqujjaman, Md. Arafat Rahman, Md. Zahid Hasan, Mehedi Hasan, and Sayem Ahmed

Subjects
Adult, Male, medicine.medical_specialty, Cross-sectional study, Population, Concentration index, Lower risk, 03 medical and health sciences, Prevalence, medicine, Humans, Undiagnosed hypertension, education, Socioeconomic status, Aged, Bangladesh, education.field_of_study, 030505 public health, business.industry, Research, lcsh:Public aspects of medicine, Health Policy, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Health Status Disparities, Middle Aged, Non-communicable disease, medicine.disease, Health Surveys, Cross-Sectional Studies, Blood pressure, Hypertension, Female, Underweight, medicine.symptom, 0305 other medical science, business, Demography
Abstract

Background In recent years, developing countries like Bangladesh are facing a higher burden of non-communicable diseases such as hypertension as a result of demographic transition. Prevalence of hypertension is often studied in this setting. However, evidence on undiagnosed hypertension is not widely available in the existing literature. Therefore, the current study focuses on inequalities in the prevalence of undiagnosed hypertension in Bangladesh. Methods A total of 8835 participants aged 35+ years were included in this study using nationally representative Bangladesh Demographic and Health Survey 2011 (BDHS). In the survey, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of these participants were measured three times with approximately 10 minutes of an interval between each measurement. Any respondent with either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was considered as patient with hypertension as per the guidelines from American Heart Association. Among the participants, undiagnosed hypertension was defined as having SBP > =140 mmHg or DBP > =90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure. Multiple logistic regression analysis was applied for identifying factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (C). Results We found 978 (59.9% of the total) were undiagnosed among 1685 hypertensive patients studied. Regression analysis showed individuals with being underweight, having poor socioeconomic conditions, and lower educational qualifications were more likely to have undiagnosed hypertension. A similar association between undiagnosed hypertension and socioeconomic quintiles was observed using concentration index (C = − 0.07). On the other hand, individuals from higher age group (50–64 or above), female sex, and Sylhet region were at lower risk of undiagnosed hypertension. Conclusions This study showed that a large proportion of the cases with hypertension are remained undiagnosed in Bangladesh, especially among the poor and low educated population. Screening and awareness building initiatives on hypertension should be taken for this group of population to reduce the burden of undiagnosed hypertension.

Published
2019

39. Role of Qualified Physicians as Antenatal Care Providers in Reducing Birth Complications in Home-delivered Rural Women in Bangladesh

Author

Md. Tariqujjaman, Md. Zakiul Hassan, Mohammad Abdullah Heel Kafi, Md. Golam Dostogir G. Harun, and Faisal Ahmmed

Subjects
medicine.medical_specialty, rural women, 030204 cardiovascular system & hematology, mixed effect, home delivery, 03 medical and health sciences, 0302 clinical medicine, antenatal care, Health facility, medicine, delivery complications, demographic health survey, Pregnancy, Government, business.industry, General Engineering, medicine.disease, qualified physician, Delivery complications, Family medicine, Public Health, Rural area, Neonatal death, Rural women, business, 030217 neurology & neurosurgery, Medical doctor
Abstract

Introduction Bangladesh has made significant strides in maternal and neonatal death by ensuring qualified antenatal care (ANC) visits during the pregnancy period of women. To ensure this qualified ANC, the government of Bangladesh has increased the number of qualified physicians and skilled birth attendants at health facilities and encouraged pregnant women to take this eligible ANC during pregnancy. Despite this progress, the majority of deliveries among rural women still occur at home, assisted by traditional birth attendants. These traditional birth attendants at home or even skilled birth attendants at the health facility or home are not always cable of helping women to overcome severe delivery complications. Proper birth preparation before pregnancy through qualified ANC might be a solution here. Taking advice for appropriate birth preparation from a qualified physician (medical doctor) would ensure qualified ANC. In this study, we examined how ANC from a qualified physician, as compared to other trained providers, influences rural women delivering at home to prepare for birth and reduces severe delivery complications. Methods The data of 1554 rural women who delivered at home were extracted from the 2014 Bangladesh Demographic and Health Survey data. A mixed-effects logistic regression model was carried out for the binary delivery complications data, to assess the influence of qualified physicians as ANC providers on delivery complications by adjusting the effect of other socio-demographic covariates and clustering. Results Of the women from rural areas who delivered at home, 42% reported delivery complications. Those who received ANC from a qualified physician were 32% less likely (OR 0.68; 95% CI 0.50, 0.91) to report facing delivery complications as compared to those who had received ANC from other trained or unqualified providers adjusted by socio-demographic determinants in Bangladesh. Conclusions Developing a sustained and effective strategy could be a precedent for promoting ANC from qualified physicians for rural women delivering at home, to decrease delivery complications as well as creating healthy environments for safe deliveries.

Published
2019

40. Additional file 5: of Does health worker performance affect clientsâ health behaviors? A multilevel analysis from Bangladesh

Author

Epstein, Adrienne, Corrina Moucheraud, Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, Glenn, Jeffrey, Bossert, Thomas, and Kruk, Margaret

Abstract

Relationship between counseling quality and client IYCF practices adjusting for client knowledge score. Regression results evaluating relationship between counseling compliance and caregiver IYCF behaviors, adjusting for caregiver knowledge. (DOCX 13 kb)

Published
2019
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41. Additional file 6: of Does health worker performance affect clientsâ health behaviors? A multilevel analysis from Bangladesh

Author

Epstein, Adrienne, Corrina Moucheraud, Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, Glenn, Jeffrey, Bossert, Thomas, and Kruk, Margaret

Abstract

Relationship between counseling quality and client IYCF practices adjusting for health worker covariates (sensitivity analysis). Regression results evaluating relationship between counseling compliance and caregiver IYCF behaviors, adjusting for health worker characteristics. (DOCX 14 kb)

Published
2019
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42. Additional file 1: of Does health worker performance affect clientsâ health behaviors? A multilevel analysis from Bangladesh

Author

Epstein, Adrienne, Corrina Moucheraud, Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, Glenn, Jeffrey, Bossert, Thomas, and Kruk, Margaret

Abstract

Health worker survey: self-efficacy and job satisfaction module. Module from health worker survey used to generate self-efficacy and job satisfaction scores not included in the publicly available health worker survey. (DOCX 19 kb)

Published
2019
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43. Additional file 3: of Does health worker performance affect clientsâ health behaviors? A multilevel analysis from Bangladesh

Author

Epstein, Adrienne, Corrina Moucheraud, Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, Glenn, Jeffrey, Bossert, Thomas, and Kruk, Margaret

Subjects
behavioral disciplines and activities
Abstract

Full list of items included in service observation score. List of items from service observation checklist used to generate service observation score for each community health worker. (DOCX 18 kb)

Published
2019
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44. Additional file 4: of Does health worker performance affect clientsâ health behaviors? A multilevel analysis from Bangladesh

Author

Epstein, Adrienne, Corrina Moucheraud, Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, Glenn, Jeffrey, Bossert, Thomas, and Kruk, Margaret

Abstract

Full list of individual items included in knowledge, self-efficacy, and satisfaction composite measures. List of items from surveys used to generate knowledge, self-efficacy, and satisfaction composite measures for both health workers and caregivers. (DOCX 14 kb)

Published
2019
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45. Prevalence and correlates of HIV/AIDS knowledge among ever married women of reproductive age in Bangladesh: an update from the Bangladesh Demographic and Health Survey 2014

Author

Md. Tariqujjaman, Aninda Nishat Moitry, Haribondu Sarma, Mohammad Abdullah Heel Kafi, Syed Quamrul Huda, Mahfuzur Rahman, Md. Rashidul Azad, Md. Mehedi Hasan, Mohammad Bellal Hossain, and Samira Dishti Irfan

Subjects
business.industry, Age at first marriage, media_common.quotation_subject, Knowledge level, Reproductive age, medicine.disease, Odds, Promotion (rank), Acquired immunodeficiency syndrome (AIDS), General Earth and Planetary Sciences, Medicine, business, Disease burden, General Environmental Science, Mass media, media_common, Demography
Abstract

Background: Knowledge about HIV/AIDS is crucial to prevent the HIV/AIDS disease burden, especially for women of reproductive age to protect their offspring from mother-to-child transmissions of HIV/AIDS. This study aims to explore the prevalence and correlates of HIV/AIDS knowledge among ever-married reproductive women in Bangladesh. Methods: Data were extracted from a nationally representative two-stage stratified Bangladesh Demographic and Health Survey (BDHS) conducted in 2014. Knowledge level of women regarding HIV/AIDS was constructed by scoring 11 dichotomous knowledge questions and classified into low, moderate and high level by using the principal component analysis. Multiple multinomial logistic regression model was fitted to identify the correlates. Results: Among 17,863 ever-married women of reproductive age, 70% had ever heard about HIV/AIDS, and 34.2% had low, 33.0% had moderate and 32.8% had high level of HIV/AIDS knowledge. Women with age at first marriage between 15-19 years and ≥20 years of age were respectively 1.18 and 1.85 times more likely to have high HIV/AIDS knowledge than women who got married before 15 years of age. Compared to illiterate women, women who completed primary and secondary or higher education had higher odds of having both moderate and high HIV/AIDS knowledge. Women exposed to mass-media were 2.39 and 2.91 times more likely to have moderate and high HIV/AIDS knowledge respectively than women without mass-media exposure. Conclusions: Findings of this study stress the importance of building awareness regarding the transmissions and consequences of HIV/AIDS among women of reproductive age in order to avert the risk of further spread. Through promotion of female education, incorporation of HIV/AIDS teaching in the national curriculum and vigorous mass media campaigns, women’s awareness about HIV/AIDS can be enhanced effectively. Also, strict enforcement of policy to prevent early marriage will aid in better control of HIV in Bangladesh.

Published
2020

47. Household food insecurity and unimproved toilet facilities associate with child morbidity: evidence from a cross-sectional study in Bangladesh

Author

Mohammad Ashraful Islam, Mahfuzur Rahman, Md. Fakhar Uddin, Md. Tariqujjaman, Gobinda Karmakar, Mohammad Ashikur Rahman, Matthew Kelly, Darren Gray, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Household food insecurity, Sanitation, Under-five children, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Despite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Evidence regarding the consequencs of household FI and poor sanitation on child morbidity is scarce. This study aimed to understand the association of FI and unimproved toilet facility with morbidity status of under-5 children in Bangladesh. Methods We used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in 9 districts of Bangladesh. The study population included children aged 6–59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders. Results A total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95). Conclusions Our study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is recommended to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.

Published
2022
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48. Does health worker performance affect clients’ health behaviors? A multilevel analysis from Bangladesh

Author

Adrienne Epstein, Corrina Moucheraud, Haribondhu Sarma, Mahfuzur Rahman, Md. Tariqujjaman, Tahmeed Ahmed, Jeffrey Glenn, Thomas Bossert, and Margaret E. Kruk

Subjects
health behavior, counseling, evidence-based practice, nutrition, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Suboptimal healthcare quality may be a barrier to achieving child health improvements, yet little is known about the relationship between provider compliance with evidence-based practices and client behavior change. We assess provider compliance in the context of infant and young child feeding (IYCF) counseling, its relationship with client IYCF behaviors in Bangladesh, and explore its potential determinants. Methods We use data from a 2017 evaluation of an IYCF program that includes a health worker survey (n = 74), caregiver survey (n = 232), and direct service observation checklists of counseling sessions (n = 232 observations of 74 health workers). We assess the relationship between provider compliance with recommended IYCF counseling topics and behaviors (standardized to a 100-point scale) and three reported IYCF behaviors among clients using multi-level models with random effects at the health worker and sub-district (sampling) levels. We also evaluate whether health worker self-efficacy, satisfaction, and technical knowledge are associated with provider compliance. Results Health worker compliance was significantly associated with reported exclusive breastfeeding for children under 6 months of age (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.06, 95% CI 1.01, 1.12) and marginally associated with minimum dietary diversity (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.05, 95% CI 1.00, 1.11). Counseling compliance was significantly and positively associated with both health worker self-efficacy and technical knowledge. Conclusions We find evidence for an association between health worker compliance and client health behaviors; however, small effect sizes suggest that behavior change is multifactorial and affected by factors beyond care quality. Improvements to technical quality of care may contribute to desired health outcomes; but policies and programs seeking to change health behaviors through counseling may also wish to target upstream factors such as self-efficacy, alongside technical skill-building and knowledge, for maximum impact.

Published
2019
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49. Inequalities in the prevalence of undiagnosed hypertension among Bangladeshi adults: evidence from a nationwide survey

Author

Sayem Ahmed, Md. Tariqujjaman, Md. Arafat Rahman, Md. Zahid Hasan, and Md. Mehedi Hasan

Subjects
Undiagnosed hypertension, Non-communicable disease, Concentration index, Bangladesh, Public aspects of medicine, RA1-1270
Abstract

Abstract Background In recent years, developing countries like Bangladesh are facing a higher burden of non-communicable diseases such as hypertension as a result of demographic transition. Prevalence of hypertension is often studied in this setting. However, evidence on undiagnosed hypertension is not widely available in the existing literature. Therefore, the current study focuses on inequalities in the prevalence of undiagnosed hypertension in Bangladesh. Methods A total of 8835 participants aged 35+ years were included in this study using nationally representative Bangladesh Demographic and Health Survey 2011 (BDHS). In the survey, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of these participants were measured three times with approximately 10 minutes of an interval between each measurement. Any respondent with either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was considered as patient with hypertension as per the guidelines from American Heart Association. Among the participants, undiagnosed hypertension was defined as having SBP > =140 mmHg or DBP > =90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure. Multiple logistic regression analysis was applied for identifying factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (C). Results We found 978 (59.9% of the total) were undiagnosed among 1685 hypertensive patients studied. Regression analysis showed individuals with being underweight, having poor socioeconomic conditions, and lower educational qualifications were more likely to have undiagnosed hypertension. A similar association between undiagnosed hypertension and socioeconomic quintiles was observed using concentration index (C = − 0.07). On the other hand, individuals from higher age group (50–64 or above), female sex, and Sylhet region were at lower risk of undiagnosed hypertension. Conclusions This study showed that a large proportion of the cases with hypertension are remained undiagnosed in Bangladesh, especially among the poor and low educated population. Screening and awareness building initiatives on hypertension should be taken for this group of population to reduce the burden of undiagnosed hypertension.

Published
2019
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50. Unintended consequences of programmatic changes to infant and young child feeding practices in Bangladesh

Author

Md. Tariqujjaman, Mahfuzur Rahman, Sharmin Khan Luies, Gobinda Karmakar, Tahmeed Ahmed, and Haribondhu Sarma

Subjects
Bangladesh, community health workers, infant and young child feeding, micronutrient powder, unintended consequences, Pediatrics, RJ1-570, Gynecology and obstetrics, RG1-991, Nutritional diseases. Deficiency diseases, RC620-627
Abstract

Abstract BRAC, an international development organization, implemented a home‐fortification programme from 2014 to 2018 in Bangladesh. This study aimed to understand the unintended consequences of programmatic changes that occurred during the implementation of the programme on the prevalence of good infant and young child feeding (IYCF) practices and other associated factors. We used pooled data from eight cross‐sectional surveys and data from a series of qualitative investigations carried out as part of a mixed‐methods evaluation approach. A total of 6,479 caregivers of children aged 6 to 23 months participated in the surveys. The prevalence of good IYCF practices increased from baseline (42.1%) to midline (45.3%), but it decreased at the endline survey (31.9%). Qualitative investigations identified several reasons for low IYCF practices at the programme level, such as the withdrawal of community health worker (CHW) incentives for promoting IYCF, providing incentives for the home‐fortification of micronutrient powder (MNP) and changing the focus from IYCF promotion to MNP promotion. A multivariable generalized estimating equation model for pooled data revealed that caregivers were 28% (adjusted risk ratio [ARR]: 0.72, 95% CI [0.67, 0.78]) less likely to maintain good IYCF practices during the period when CHWs were not incentivized to promote IYCF compared to the period when CHWs were incentivized to promote it. The prevalence of good IYCF practices decreased from both baseline and midline to the endline survey due to the unintended consequences of the programmatic changes. An integrated intervention strategy to promote the home‐fortification of MNP and IYCF could be helpful to avoid unintended negative consequences of programmatic changes.

Published
2021
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